CURB-65 plus hypoalbuminemia: a new score system for prediction of the in-hospital mortality risk in patients with SARS-CoV-2 pneumonia

Alessandra Oliva; Cristian Borrazzo; Maria Teresa Mascellino; Ambrogio Curtolo; Dania Al Ismail; Francesca Cancelli; Gioacchino Galardo; Tommaso Bucci; Giancarlo Ceccarelli; Gabriella d'Ettorre; Francesco Pugliese; Claudio M Mastroianni; Mario Venditti

doi:10.53854/liim-2903-12

CURB-65 plus hypoalbuminemia: a new score system for prediction of the in-hospital mortality risk in patients with SARS-CoV-2 pneumonia

Infez Med. 2021 Sep 10;29(3):408-415. doi: 10.53854/liim-2903-12. eCollection 2021.

Affiliations

¹ Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome Italy.
² Medical Emergency Unit, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.
³ Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Sapienza University of Rome, Rome, Italy.
⁴ Anesthesiology and Intensive Care group, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.

Abstract

Introduction: There is the need of a simple but highly reliable score system for stratifying the risk of mortality and Intensive Care Unit (ICU) transfer in patients with SARS-CoV-2 pneumonia at the Emergency Room.

Purpose: In this study, the ability of CURB-65, extended CURB-65, PSI and CALL scores and C-Reactive Protein (CRP) to predict intra-hospital mortality and ICU admission in patients with SARS-CoV-2 pneumonia were evaluated.

Methods: During March-May 2020, a retrospective, single-center study including all consecutive adult patients with diagnosis of SARS-CoV-2 pneumonia was conducted. Clinical, laboratory and radiological data as well as CURB-65, expanded CURB-65, PSI and CALL scores were calculated based on data recorded at hospital admission.

Results: Overall, 224 patients with documented SARS-CoV-2 pneumonia were included in the study. As for intrahospital mortality (24/224, 11%), PSI performed better than all the other tested scores, which showed lower AUC values (AUC=0.890 for PSI versus AUC=0.885, AUC=0.858 and AUC=0.743 for expanded CURB-65, CURB-65 and CALL scores, respectively). Of note, the addition of hypoalbuminemia to the CURB-65 score increased the prediction value of intra-hospital mortality (AUC=0.905). All the tested scores were less predictive for the need of ICU transfer (26/224, 12%), with the best AUC for extended CURB-65 score (AUC= 0.708).

Conclusion: The addition of albumin level to the easy-to-calculate CURB-65 score at hospital admission is able to improve the quality of prediction of intra-hospital mortality in patients with SARS-CoV-2 pneumonia.

Keywords: CALL score; CRP; CURB-65; ICU admission; PSI score; extended CURB-65; hypoalbuminemia; mortality.