Performance of Pneumonia Severity Index and CURB-65 in Predicting 30-day mortality in patients with COVID-19

Int J Infect Dis. 2020 Jun 14;S1201-9712(20)30473-2. doi: 10.1016/j.ijid.2020.06.038. Online ahead of print.

Abstract

Objective: The aim of the study was to analyze the usefulness of the CURB-65 and pneumonia severity index (PSI) in predicting 30-day mortality in patients with COVID-19 and to identify other factors associated with higher mortality.

Methods: A retrospective study was performed at a pandemic hospital in Istanbul, Turkey and 681 laboratory-confirmed patients with COVID-19 were included. Data on characteristics, vital signs and laboratory parameters were recorded form electronic medical records. We used receiver operating characteristic analysis to quantify the discriminatory abilities of the prognostic scales. Univariate and multivariate logistic regression analyses were performed to identify other predictors of mortality.

Results: Higher CRP levels were associated with an increased risk for mortality (OR:1.015, 95% CI 1.008 to 1.021, p < 0.001). The PSI performed significantly better than the CURB-65 (AUC: 0.91, 95% CI 0.88-0.93 vs AUC:0.88, 95% CI:0.85-0.90; p = 0.01) and the addition of CRP levels to PSI did not improve the performance of PSI in predicting mortality (AUC: 0.91, 95% CI 0.88-0.93 vs AUC:0.92, 95% CI:0.89-0.94; p = 0.29).

Conclusion: In a large group of hospitalized patients with COVID-19, we found that PSI performed better than CURB-65 in predicting mortality. Adding CRP levels to PSI did not improve the 30-day mortality prediction.

Keywords: COVID-19; CURB-65; Pneumonia; Pneumonia severity index; Prognosis; mortality.