key: cord-0856459-9clo0nsf authors: Su, Ying; Tu, Guo-wei; Ju, Min-jie; Yu, Shen-ji; Zheng, Ji-li; Ma, Guo-guang; Liu, Kai; Ma, Jie-fei; Yu, Kai-huan; Xue, Yuan; Luo, Zhe title: Comparison of CRB-65 and quick sepsis-related organ failure assessment for predicting the need for intensive respiratory or vasopressor support in patients with COVID-19 date: 2020-05-07 journal: J Infect DOI: 10.1016/j.jinf.2020.05.007 sha: 4f1ca7bf26469a1c7bbe6312fa7e3a586b3d3d1c doc_id: 856459 cord_uid: 9clo0nsf nan We read the recent published paper by Chen and colleagues in journal of Infection with great interest, which described the clinical progression of patients with COVID-19 in Shanghai, China(1) . Since December 2019, an outbreak of coronavirus disease 2019 (COVID-19) emerged in Wuhan, China and spread globally to become a public health emergency of international concern(2). Patients with COVID-19 tend to progress after onset of symptoms within 7 days(1) and severe type may rapidly progress to acute respiratory distress syndrome (ARDS) or end-organ failure (3, 4) . Therefore, early and simple identification of patients who require intensive respiratory or vasopressor support (IRVS) would be of considerable value during the outbreak of the COVID-19 crisis. Thus far, there are no effective severity assessment tools for patients with COVID-19. Here, we performed a retrospective single-center study to compare the performance of simple score systems such as quick sepsis-related organ failure 3 3 assessment (qSOFA), the CURB-65 score adopted by the British Thoracic Society, ROC curve analyses were performed to evaluate the performance of four simple score systems to predict the need for IRVS. The AUC, optimal cut-off value, sensitivity, specificity, and positive and negative predictive values of each score system were shown in Table 2 . The optimal cut-off score of CRB-65 for prediction of IRVS was 2, which provided sensitivity of 64% and specificity of 93.4%. The AUC values of the CRB-65 score in predicting the need for IRVS were much higher than those for the qSOFA score (0.81 ± 0.05 vs. 0.70 ± 0.06, P=0.02). The CRB-65 had higher AUC values than CRB score for IRVS prediction, however, the difference was not statistically significant (0.81 ± 0.05 vs. 0.77 ± 0.05, P=0.22). The AUC values were comparable between CRB-65 and CURB-65 for IRVS prediction (0.81 ± 0.05 vs. 0.85 ± 0.05, P=0.08). To the best of our knowledge, the present study is the first to investigate the 4 4 predictive performance of simple score systems in patients with COVID-19. In this study, the CRB-65 score could better identify patients with COVID-19 at risk for IRVS than the qSOFA score. The CRB score contains the same three clinical parameters used in qSOFA score (confusion, respiratory rate, and blood pressure). However, the thresholds for tachypnea and hypotension in CRB were stricter than the qSOFA score (respiratory rate ≥ 30/min in CRB vs. ≥ 22/min in qSOFA; blood pressure: systolic blood pressure ≤ 100 mmHg in qSOFA vs. < 90 mmHg sys or ≤ 60 mmHg dias in CRB). It seems that qSOFA is more accurate than the CRB score for predicting IRVS. However, in this study, the AUC values of CRB and qSOFA scores were comparable without statistically significant differences. After including the parameter of age, the CRB-65 score performed better than the qSOFA score in predicting requirement of IRVS. As age ≥ 65 years was included in the CRB-65 score, it provided additional predictive performance compared with the CRB score. This result was supported by previous reports, which showed that age was an independent risk factor for mortality in patients with COVID-19(5, 6). The CRB-65 score has been reported to have a similar predictive performance to that of the CURB-65 and PSI scores in predicting the severity of CAP (7) (8) (9) . In our study, the CRB-65 and CURB-65 scores also had a similar prognostic value in predicting the receipt of IRVS. The CRB-65 score makes it easy to assess the severity of COVID-19 without the limit of laboratory data for blood urea nitrogen especially in the pandemic of COVID-19, thereby allowing earlier triage decisions. In conclusion, the CRB-65 score could better identify patients with COVID-19 at risk for IRVS than the qSOFA score. The CRB-65 may be a useful score tool for COVID-19 because of its simplicity in application especially in emergent and complicated conditions. The authors declare that they have no competing interests. Clinical progression of patients with COVID-19 in The epidemiological and clinical features of COVID-19 and lessons from this global infectious public health event Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis Clinical features of COVID-19 in elderly patients: A comparison with young and middle-aged patients Review: CURB65, CRB65, and Pneumonia Severity Index similarly predict mortality in community-acquired pneumonia Severity assessment tools for predicting mortality in hospitalised patients with community-acquired pneumonia. Systematic review and meta-analysis Lactate dehydrogenase as a prognostic marker of renal transplant recipients with severe community-acquired pneumonia: a 10-year retrospective study Abbreviations: AUROC, area under the receiver operating characteristic curve; CI, confidence interval; LR, likelihood ratio CRB, confusion, respiratory rate, and blood pressure CRB-65, confusion, respiratory rate, blood pressure and age ≥65 years; CURB-65, confusion, urea nitrogen, respiratory rate, blood pressure and age ≥65 years; qSOFA, quick Sepsis-related Bold: the optimal cut-off values according to Youden index. AUC comparisons CRB-65 vs. qSOFA, P=0.02; CRB-65 vs. CRB, P=0.22; CRB-65 vs. CURB-65 The authors the great sacrifice and contribution of people from Wuhan, Hubei province, China.