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

DoÄŸanay, Fatih; Ak, Rohat

BACKGROUND In the COVID-19 pandemic, difficulties have been experienced in the provision of healthcare services due to excessive patient admissions to hospitals and emergency departments. It has become important to use clear and objective criteria for early diagnosis of patients with high-risk classification and clinical worsening risk. OBJECTIVE The aim of this study was to assess the prognostic accuracy of CURB-65, ISARIC-4C, and COVID-GRAM scores in patients hospitalized for COVID-19 and to compare the scoring systems in terms of predicting in-hospital mortality and intensive care unit requirement. METHODS The files of all COVID-19 patients over the age of 18 who were admitted to the emergency department and hospitalized 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. RESULTS There 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. CONCLUSIONS Among 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.