Pre-test probability for SARS-Cov-2-related Infection Score: the PARIS score

Tordjman, M.; Mekki, A.; Mali, R. D.; Saab, I.; Chassagnon, G.; Guillo, E.; Burns, R.; Eshagh, D.; Beaune, S.; Madelin, G.; Bessis, S.; Feydy, A.; Mihoubi, F.; Doumenc, B.; Carlier, R.-Y.; Drape, J.-L.; Revel, M.-P.

Background: Diagnostic tests for SARS-CoV-2 infection (mostly RT-PCR and Computed Tomography) are not widely available in numerous countries, expensive and with imperfect performance Methods: This multicenter retrospective study aimed to determine a pre-test probability score for SARS-CoV-2 infection based on clinical and biological variables. Patients were recruited from emergency and infectious disease departments and were divided into a training and a validation cohort. Demographic characteristics, clinical symptoms, and results of blood tests (complete white blood cell count, serum electrolytes and CRP) were collected. The pre-test probability score was derived from univariate analyses between patients and controls, followed by multivariate binary logistic analysis to determine the independent variables associated with SARS-CoV-2 infection. Points were assigned to each variable to create the PARIS score. ROC curve analysis determined the area under the curve (AUC) Findings: One hundred subjects with clinical suspicion of SARS-CoV-2 infection were included in the training cohort, and 300 other consecutive individuals were included in the validation cohort. Low lymphocyte (<1.3 G/L), eosinophil (<0.06G/L), basophil (<0.04G/L) and neutrophil counts (<5G/L) were associated with a high probability of SARS-CoV-2 infection. No clinical variable was statistically significant. The score had a good performance in the validation cohort (AUC=0.889 (CI: [0.846-0.932]; STD=0.022) with a sensitivity and Positive Predictive Value of high-probability score of 80.3% and 92.3% respectively. Furthermore, a low-probability score excluded SARS-CoV-2 infection with a Negative Predictive Value of 99.5% Interpretation: The PARIS score based on complete white blood cell count has a good performance to categorize the pre-test probability of SARS-CoV-2 infection. It could help clinicians avoid diagnostic tests in patients with a low-probability score and conversely keep on testing individuals with high-probability score but negative RT-PCR or CT. It could prove helpful in countries with a low-availability of PCR and/or CT during the current period of pandemic