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Review 1: "The utility of established prognostic scores in COVID-19 hospital admissions: a multicentre prospective evaluation of CURB-65, NEWS2, and qSOFA"

This robust analysis is novel and of high interest for the medical community. This study informs how new prognostic scores should be created to more accurately guide clinical decision-making in patients with COVID-19.

Published onAug 25, 2020
Review 1: "The utility of established prognostic scores in COVID-19 hospital admissions: a multicentre prospective evaluation of CURB-65, NEWS2, and qSOFA"
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key-enterThis Pub is a Review of
The utility of established prognostic scores in COVID-19 hospital admissions: a multicentre prospective evaluation of CURB-65, NEWS2, and qSOFA
Description

INTRODUCTION The COVID-19 pandemic is ongoing yet, due to the lack of a COVID-19 specific tool, clinicians must use pre-existing illness severity scores for initial prognostication. However, the validity of such scores in COVID-19 is unknown. METHODS The North West Collaborative Organization for Respiratory Research (NW-CORR) performed a multi-centre prospective evaluation of adult patients admitted to hospital with confirmed COVID-19 during a two-week period in April 2020. Clinical variables measured as part of usual care at presentation to hospital were recorded, including the CURB-65, NEWS2, and qSOFA scores. The primary outcome of interest was 30-day mortality. RESULTS Data were collected for 830 people with COVID-19 admitted across 7 hospitals. By 30 days, a total of 300 (36.1%) had died and 142 (17.1%) had been in ICU. All scores underestimated mortality compared to their original validation in non-COVID-19 populations, and overall prognostic performance was generally poor. Among the 9low risk9 categories (CURB-65<2, NEWS2<5, qSOFA<2) 30-day mortality was 16.7%, 32.9% and 21.4%, respectively. Multivariable logistic regression identified features of respiratory compromise rather than circulatory collapse as most relevant prognostic variables. CONCLUSION All existing prognostic scores evaluated here underestimated adverse outcomes and performed sub-optimally in the COVID-19 setting. New prognostic tools including a focus on features of respiratory compromise rather than circulatory collapse are needed. We provide a baseline set of variables which are relevant to COVID-19 outcomes and may be used as a basis for developing a bespoke COVID-19 prognostication tool.

The manuscript is well written, well structured, easy to understand and strictly problem and hypothesis related. The findings are new and of high interest for the medical community (emergency physicians, ICU, respiratory medicine, internal medicine, infection) COVID-19 related.

The study design is appropriate despite a bias because of local circumstances cannot be excluded—but results are clear such that results should be published immediately.

The conclusions are correctly drawn and supported by the data and results. There are no ethical concerns.

Minor comment: If there is a better citation of reference 10, please add. I recommend publication strongly and rapidly. No Revision required.

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