External Validation and Recalibration of the CURB-65 and PSI for Predicting 30-Day Mortality and Critical Care Intervention in Multiethnic Patients with COVID-19

https://doi.org/10.1016/j.ijid.2021.08.027Get rights and content
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Highlights

  • Low levels of COVID-19 mortality, and high diversity in the Qatari population.

  • PSI and CURB-65 were assessed for predicting COIVD-19 mortality and CCI.

  • We modified PSI/CURB-65 models to predict CCI using LASSO with logistic regression.

  • The PSI performed better than CURB-65 for predicting mortality.

  • The CURB-65 outperformed PSI in predicting CCI.

Abstract

Objectives: To validate and recalibrate the CURB-65 and pneumonia severity index (PSI) in predicting 30-day mortality and critical care intervention (CCI) in a multiethnic population with COVID-19, along with evaluating both models in predicting CCI.

Methods: Retrospective data was collected for 1181 patients admitted to the largest hospital in Qatar with COVID-19 pneumonia. The area under the curve (AUC), calibration curves, and other metrics were bootstrapped to examine the performance of the models. Variables constituting the CURB-65 and PSI scores underwent further analysis using the Least Absolute Shrinkage and Selection Operator (LASSO) along with logistic regression to develop a model predicting CCI. Complex machine learning models were built for comparative analysis.

Results: The PSI performed better than CURB-65 in predicting 30-day mortality (AUC 0.83, 0.78 respectively), while CURB-65 outperformed PSI in predicting CCI (AUC 0.78, 0.70 respectively). The modified PSI/CURB-65 model (respiratory rate, oxygen saturation, hematocrit, age, sodium, and glucose) predicting CCI had excellent accuracy (AUC 0.823) and good calibration.

Conclusions: Our study recalibrated, externally validated the PSI and CURB-65 for predicting 30-day mortality and CCI, and developed a model for predicting CCI. Our tool can potentially guide clinicians in Qatar to stratify patients with COVID-19 pneumonia.

Keywords

COVID-19
CURB-65
PSI
mortality
critical care intervention

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Both authors contributed equally to this manuscript.