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Prognostication of COVID-19 patients using ROX index and CURB-65 score - A retrospective observational study
Poonam Arora1, Takshak Shankar1, Shrirang Joshi1
1Department of Emergency Medicine, AIIMS Rishikesh, Uttarakhand, India.
Insights
The ROX index and CURB-65 score are effective tools for stratifying COVID-19 patients. These simple bedside scores help predict hospitalization and mortality, aiding primary care physicians in resource allocation.
Area of Science:
- Emergency Medicine
- Infectious Diseases
- Public Health
Background:
- Coronavirus disease-2019 (COVID-19) has strained global healthcare systems, particularly intensive care units (ICUs).
- Effective patient stratification is crucial for rational allocation of limited hospital resources.
- Simple, reproducible bedside scores are needed for primary care settings.
Purpose of the Study:
- To evaluate the utility of the ROX index and CURB-65 score in stratifying COVID-19 patients.
- To correlate these scores with hospitalization needs and mortality outcomes.
- To determine the predictive accuracy of these bedside scores.
Main Methods:
- Retrospective study of 842 adult COVID-19 patients admitted from May to November 2020.
- Calculation of ROX index and CURB-65 scores upon emergency department (ED) arrival.
- Correlation of scores with hospitalization, 14-day, and 28-day mortality.
Main Results:
- The ROX index demonstrated high predictive accuracy for hospitalization (AUROC 0.924) and mortality (14-day AUROC 0.909, 28-day AUROC 0.933).
- The CURB-65 score also showed strong predictive power for hospitalization (AUROC 0.845) and mortality (14-day AUROC 0.905, 28-day AUROC 0.902).
- Optimal cut-offs were identified for both scores to predict hospitalization and mortality.
Conclusions:
- The ROX index and CURB-65 score are simple, inexpensive, and effective tools for risk stratification of COVID-19 patients.
- These scores can be readily used by primary care physicians to guide clinical decisions and resource allocation.
- Utilizing these bedside scores can improve patient management and outcomes in the context of the COVID-19 pandemic.
Objectives:
Coronavirus disease-2019 (COVID-19) disease has overwhelmed the healthcare infrastructure worldwide. The shortage of intensive care unit (ICU) beds leads to longer waiting times and higher mortality for patients. High crowding leads to an increase in mortality, length of hospital stays, and hospital costs for patients. Through an appropriate stratification of patients, rational allocation of the available hospital resources can be accomplished. Various scores for risk stratification of patients have been tried, but for a score to be useful at primary care level, it should be readily available at the bedside and be reproducible. ROX index and CURB-65 are simple bedside scores, requiring minimum equipment, and investigations to calculate.
Methods:
This retrospective, record-based study included adult patients who presented to the ED from May 1, 2020 to November 30, 2020 with confirmed COVID-19 infection. The patient's clinical and demographic details were obtained from the electronic medical records of the hospital. ROX index and CURB-65 score on ED arrival were calculated and correlated with the need for hospitalization and early (14-day) and late (28-day) mortality.
Results:
842 patients were included in the study. The proportion of patients with mild, moderate and severe disease was 46.3%, 14.9%, and 38.8%, respectively. 55% patients required hospitalization. The 14-day mortality was 8.8% and the 28-day mortality was 20.7%. The AUROC of ROX index for predicting hospitalization was 0.924 (p < 0.001), for 14-day mortality was 0.909 (p < 0.001) and for 28-day mortality was 0.933 (p < 0.001). The AUROC of CURB-65 score for predicting hospitalization was 0.845 (p < 0.001), for 14-day mortality was 0.905 (p < 0.001) and for 28-day mortality was 0.902 (p < 0.001). The cut-off of ROX index for predicting hospitalization was ≤18.634 and for 14-day mortality was ≤14.122. Similar cut-off values for the CURB-65 score were ≥1 and ≥2, respectively.
Conclusion:
ROX index and CURB-65 scores are simple and inexpensive scores that can be efficiently utilised by primary care physicians for appropriate risk stratification of patients with COVID-19 infection.
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