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dc.contributor.authorLiu, Alexander Qichen
dc.contributor.authorHammond, Robert
dc.contributor.authorChan, Kenneth
dc.contributor.authorChukwuenweniwe, Chukwugozie
dc.contributor.authorJohnson, Rebecca
dc.contributor.authorKhair, Duaa
dc.contributor.authorDuck, Eleanor
dc.contributor.authorOlubodun, Oluwaseun
dc.contributor.authorBarwick, Kirstian
dc.contributor.authorBanya, Winston
dc.contributor.authorStirrup, James
dc.contributor.authorDonnelly, Peter Duncan
dc.contributor.authorKaski, Juan Carlos
dc.contributor.authorCoates, Anthony R M
dc.identifier.citationLiu , A Q , Hammond , R , Chan , K , Chukwuenweniwe , C , Johnson , R , Khair , D , Duck , E , Olubodun , O , Barwick , K , Banya , W , Stirrup , J , Donnelly , P D , Kaski , J C & Coates , A R M 2023 , ' Low CRB-65 scores effectively rule out adverse clinical outcomes in COVID-19 irrespective of chest radiographic abnormalities ' , Biomedicines , vol. 11 , no. 9 , 2423 .
dc.identifier.otherRIS: urn:7E7FBB6BB75DA9448B41AA7368955999
dc.description.abstractBackground: CRB-65 ( C onfusion; R espiratory rate ≥ 30/min; B lood pressure ≤ 90/60 mmHg; age ≥ 65 years) is a risk score for prognosticating patients with COVID-19 pneumonia. However, a significant proportion of COVID-19 patients have normal chest X-rays (CXRs). The influence of CXR abnormalities on the prognostic value of CRB-65 is unknown, limiting its wider applicability. Methods: We assessed the influence of CXR abnormalities on the prognostic value of CRB-65 in COVID-19. Results: In 589 study patients (71 years (IQR: 57–83); 57% males), 186 (32%) had normal CXRs. On ROC analysis, CRB-65 performed similarly in patients with normal vs. abnormal CXRs for predicting inpatient mortality (AUC 0.67 ± 0.05 vs. 0.69 ± 0.03). In patients with normal CXRs, a CRB-65 of 0 ruled out mortality, NIV requirement and critical illness (intubation and/or ICU admission) with negative predictive values (NPVs) of 94%, 98% and 99%, respectively. In patients with abnormal CXRs, a CRB-65 of 0 ruled out the same endpoints with NPVs of 91%, 83% and 86%, respectively. Patients with low CRB-65 scores had better inpatient survival than patients with high CRB-65 scores, irrespective of CXR abnormalities (all p < 0.05). Conclusions: CRB-65, CXR and CRP are independent predictors of mortality in COVID-19. Adding CXR findings (dichotomised to either normal or abnormal) to CRB-65 does not improve its prognostic accuracy. A low CRB-65 score of 0 may be a good rule-out test for adverse clinical outcomes in COVID-19 patients with normal or abnormal CXRs, which deserves prospective validation.
dc.subjectCoronavirus disease 2019en
dc.subjectChest X-rayen
dc.subjectDiagnostic performanceen
dc.subjectInflammatory markersen
dc.subjectRisk stratificationen
dc.subjectRA0421 Public health. Hygiene. Preventive Medicineen
dc.titleLow CRB-65 scores effectively rule out adverse clinical outcomes in COVID-19 irrespective of chest radiographic abnormalitiesen
dc.typeJournal articleen
dc.contributor.institutionUniversity of St Andrews. School of Medicineen
dc.contributor.institutionUniversity of St Andrews. Infection and Global Health Divisionen
dc.description.statusPeer revieweden

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