Proposal of COVID-19 Clinical Risk Score for the management of suspected COVID-19 cases: a case control study
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RESEARCH ARTICLE
Open Access
Proposal of COVID-19 Clinical Risk Score for the management of suspected COVID-19 cases: a case control study Sho Nakakubo1, Masaru Suzuki1* , Keisuke Kamada1, Yu Yamashita1, Junichi Nakamura1, Hiroshi Horii1, Kazuki Sato1, Munehiro Matsumoto1, Yuki Abe1, Kosuke Tsuji1, Nobuhisa Ishiguro2, Yasuyuki Nasuhara3 and Satoshi Konno1
Abstract Background: No clinical scoring system has yet been established to estimate the likelihood of coronavirus disease (COVID-19) and determine the suitability of diagnostic testing in suspected COVID-19 patients. Methods: This was a single-center, retrospective, observational study of patients with suspected COVID-19 and confirmed COVID-19. Patient background, clinical course, laboratory and computed tomography (CT) findings, and the presence of alternative diagnoses were evaluated. Clinical risk scores were developed based on clinical differences between patients with and without COVID-19. Results: Among 110 patients suspected of having COVID-19, 60.9% underwent polymerase chain reaction (PCR) testing based on the judgment of physicians. Two patients were found to have COVID-19. The clinical characteristics of 108 non-COVID-19 patients were compared with those of 23 confirmed COVID-19 patients. Patients with COVID-19 were more likely to have a history of high-risk exposures and an abnormal sense of taste and smell. The COVID-19 group had significantly higher rates of subnormal white blood cell counts, lower eosinophil counts, and lower procalcitonin levels than the non-COVID-19 group. When blood test results, CT findings, and the presence of alternative diagnoses were scored on an 11-point scale (i.e., “COVID-19 Clinical Risk Score”), the COVID-19 group scored significantly higher than the non-COVID-19 group, more than four points in the COVID-19 group. All non-COVID patients who did not undergo PCR had a score of 4 or less. Conclusions: The COVID-19 Clinical Risk Score may enable the risk classification of patients suspected of having COVID-19 and can help in decision-making in clinical practice, including appropriateness of diagnostic testing. Further studies and prospective validation with an increased sample size are required. Keywords: COVID-19, Clinical score, CT imaging, White blood cell, Eosinophil, Procalcitonin, Polymerase chain reaction test
* Correspondence: [email protected] 1 Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-ku, Sapporo 060-8638, Japan Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this articl
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