Pre-test probability for SARS-Cov-2-related infection score: The PARIS score

Tordjman, Mickael; Mekki, Ahmed; Mali, Rahul D.; Saab, Ines; Chassagnon, Guillaume; Guillo, Enora; Burns, Robert; Eshagh, Deborah; Beaune, Sebastien; Madelin, Guillaume; Bessis, Simon; Feydy, Antoine; Mihoubi, Fadila; Doumenc, Benoit; Mouthon, Luc; Carlier, Robert-Yves; Drapé, Jean-Luc; Revel, Marie-Pierre

INTRODUCTION: In numerous countries, large population testing is impossible due to the limited availability of RT-PCR kits and CT-scans. This study aimed to determine a pre-test probability score for SARS-CoV-2 infection. METHODS: This multicenter retrospective study (4 University Hospitals) included patients with clinical suspicion of SARS-CoV-2 infection. Demographic characteristics, clinical symptoms, and results of blood tests (complete white blood cell count, serum electrolytes and CRP) were collected. A pre-test probability score was derived from univariate analyses of clinical and biological variables between patients and controls, followed by multivariate binary logistic analysis to determine the independent variables associated with SARS-CoV-2 infection. RESULTS: 605 patients were included between March 10(th) and April 30(th), 2020 (200 patients for the training cohort, 405 consecutive patients for the validation cohort). In the multivariate analysis, lymphocyte (<1.3 G/L), eosinophil (<0.06 G/L), basophil (<0.04 G/L) and neutrophil counts (<5 G/L) were associated with high probability of SARS-CoV-2 infection but no clinical variable was statistically significant. The score had a good performance in the validation cohort (AUC = 0.918 (CI: [0.891–0.946]; STD = 0.014) with a Positive Predictive Value of high-probability score of 93% (95%CI: [0.89–0.96]). Furthermore, a low-probability score excluded SARS-CoV-2 infection with a Negative Predictive Value of 98% (95%CI: [0.93–0.99]). The performance of the score was stable even during the last period of the study (15-30(th) April) with more controls than infected patients. CONCLUSIONS: The PARIS score has a good performance to categorize the pre-test probability of SARS-CoV-2 infection based on complete white blood cell count. It could help clinicians adapt testing and for rapid triage of patients before test results.