Performance of the CURB-65, ISARIC-4C and COVID-GRAM scores in terms of severity for COVID-19 patients.

Abstract

BackgroundIn the COVID‐19 pandemic, difficulties have been experienced in the provision of healthcare services because of excessive patient admissions to hospitals and emergency departments. It has become important to use clear and objective criteria for the early diagnosis of patients with high‐risk classification and clinical worsening risk.ObjectiveThe aim of this study was to assess the prognostic accuracy of CURB‐65, ISARIC‐4C and COVID‐GRAM scores in patients hospitalised for COVID‐19 and to compare the scoring systems in terms of predicting in‐hospital mortality and intensive care unit requirement.MethodsThe files of all COVID‐19 patients over the age of 18 who were admitted to the emergency department and hospitalised between September 1, 2020 and December 1, 2020 were retrospectively scanned. The area under the receiver operating characteristic curve and Youden J Index were used to compare scoring systems for predicting in‐hospital mortality and intensive care requirement.ResultsThere were 481 patients included in this study. The median age of the patients was 67 (52‐79). In terms of in‐hospital mortality, the AUC of CURB‐65, ISARIC‐4C and COVID‐GRAM were 0.846, 0.784 and 0.701 respectively. In terms of intensive care requirement, the AUC of CURB‐65, ISARIC‐4C and COVID‐GRAM were 0.898, 0.797 and 0.684 respectively. In our study, Youden's J indexes of CURB‐65, ISARIC‐4C and COVID‐GRAM scores were found to be 0.59, 0.27 and 0.01 respectively, for mortality prediction of COVID‐19 patients. Whereas Youden's J indexes were found to be 0.63, 0.26 and 0.01 respectively for determining intensive care requirement.ConclusionsAmong the scoring systems assessed, CURB‐65 score had better performance in predicting in‐hospital mortality and ICU requirement in COVID‐19 patients. ISARIC‐4C has been found successful in identifying low‐risk patients and the use of the ISARIC‐4C score with CURB‐65 increases the accuracy of risk assessment.