Background The National Early Warning Score (NEWS2) is currently recommended in the UK for the risk stratification of COVID-19 patients, but little is known about its ability to detect severe cases. We aimed to evaluate NEWS2 for the prediction of severe COVID-19 outcome and identify and validate a set of blood and physiological parameters routinely collected at hospital admission to improve upon the use of NEWS2 alone for medium-term risk stratification. Methods Training cohorts comprised 1276 patients admitted to King’s College Hospital National Health Service (NHS) Foundation Trust with COVID-19 disease from 1 March to 30 April 2020. External validation cohorts included 6237 patients from five UK NHS Trusts (Guy’s and St Thomas’ Hospitals, University Hospitals Southampton, University Hospitals Bristol and Weston NHS Foundation Trust, University College London Hospitals, University Hospitals Birmingham), one hospital in Norway (Oslo University Hospital), and two hospitals in Wuhan, China (Wuhan Sixth Hospital and Taikang Tongji Hospital). The outcome was severe COVID-19 disease (transfer to intensive care unit (ICU) or death) at 14 days after hospital admission. Age, physiological measures, blood biomarkers, sex, ethnicity, and comorbidities (hypertension, diabetes, cardiovascular, respiratory and kidney diseases) measured at hospital admission were considered in the models. Results A baseline model of ‘NEWS2 + age’ had poor-to-moderate discrimination for severe COVID-19 infection at 14 days (area under receiver operating characteristic curve (AUC) in training cohort = 0.700, 95% confidence interval (CI) 0.680, 0.722; Brier score = 0.192, 95% CI 0.186, 0.197). A supplemented model adding eight routinely collected blood and physiological parameters (supplemental oxygen flow rate, urea, age, oxygen saturation, C-reactive protein, estimated glomerular filtration rate, neutrophil count, neutrophil/lymphocyte ratio) improved discrimination (AUC = 0.735; 95% CI 0.715, 0.757), and these improvements were replicated across seven UK and non-UK sites. However, there was evidence of miscalibration with the model tending to underestimate risks in most sites. Conclusions NEWS2 score had poor-to-moderate discrimination for medium-term COVID-19 outcome which raises questions about its use as a screening tool at hospital admission. Risk stratification was improved by including readily available blood and physiological parameters measured at hospital admission, but there was evidence of miscalibration in external sites. This highlights the need for a better understanding of the use of early warning scores for COVID.

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We present a mode-sum regularization prescription for computing the vacuum polarization of a scalar field in static spherically-symmetric black hole spacetimes in even dimensions. This is the first general and systematic approach to regularized vacuum polarization in higher even dimensions, building upon a previous scheme we developed for odd dimensions. Things are more complicated here since the even-dimensional propagator possesses logarithmic singularities which must be regularized. However, in spite of this complication, the regularization parameters can be computed in closed form in arbitrary even dimensions and for arbitrary metric function f (r). As an explicit example of our method, we show plots for vacuum polarization of a massless scalar field in the Schwarzschild-Tangherlini spacetime for even d = 4, ..., 10. However, the method presented applies straightforwardly to massive fields or to nonvacuum spacetimes.

We present a new mode-sum regularization prescription for computing the vacuum polarization of a scalar field in static spherically-symmetric black hole spacetimes in odd dimensions. This is the first general and systematic approach to regularized vacuum polarization in higher dimensions. Remarkably, the regularization parameters can be computed in closed form in arbitrary dimensions and for arbitrary metric function f (r). In fact, we show that inspite the increasing severity and number of the divergences to be regularized, the method presented is mostly agnostic to the number of dimensions. Finally, as an explicit example of our method, we show plots for vacuum polarization in the Schwarzschild-Tangherlini spacetime for odd d = 5, ..., 11.

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