Letter to the Editor: Variability but not admission or trends in NEWS2 score predicts clinical outcome in elderly hospitalised patients with COVID-19

Sze, Shirley; Pan, Daniel; Williams, Caroline; Wong, Nicholas; Sahota, Amandip; Bell, David L.; Tang, Julian W.; Wiselka, Martin; Stephenson, Iain; Pareek, Manish

doi:10.1016/j.jinf.2020.05.063

Cited by 24 publications

(20 citation statements)

References 5 publications

(4 reference statements)

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“…In our study, NEWS 2 had a lower performance than NEWS in predicting EDRF and IRS. This is in accordance with previous study, which demonstrated that NEWS 2 did not predict clinical outcome in elderly patients with COVID-19 ( 28 ). The possible reasons were as follows: ( 1 ) the incidence of type II respiratory failure in patients with COVID-19 was low in this study; and ( 2 ) the NEWS2 modifications to NEWS may not improve discrimination of poor outcome in hospital patients including those with type II respiratory failure ( 26 ).…”

Section: Discussionsupporting

confidence: 93%

Prognostic Accuracy of Early Warning Scores for Clinical Deterioration in Patients With COVID-19

Xie

et al. 2021

Front. Med.

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Background: Early Warning Scores (EWS), including the National Early Warning Score 2 (NEWS2) and Modified NEWS (NEWS-C), have been recommended for triage decision in patients with COVID-19. However, the effectiveness of these EWS in COVID-19 has not been fully validated. The study aimed to investigate the predictive value of EWS to detect clinical deterioration in patients with COVID-19.Methods: Between February 7, 2020 and February 17, 2020, patients confirmed with COVID-19 were screened for this study. The outcomes were early deterioration of respiratory function (EDRF) and need for intensive respiratory support (IRS) during the treatment process. The EDRF was defined as changes in the respiratory component of the sequential organ failure assessment (SOFA) score at day 3 (ΔSOFAresp = SOFA resp at day 3–SOFAresp on admission), in which the positive value reflects clinical deterioration. The IRS was defined as the use of high flow nasal cannula oxygen therapy, noninvasive or invasive mechanical ventilation. The performances of EWS including NEWS, NEWS 2, NEWS-C, Modified Early Warning Scores (MEWS), Hamilton Early Warning Scores (HEWS), and quick sepsis-related organ failure assessment (qSOFA) for predicting EDRF and IRS were compared using the area under the receiver operating characteristic curve (AUROC).Results: A total of 116 patients were included in this study. Of them, 27 patients (23.3%) developed EDRF and 24 patients (20.7%) required IRS. Among these EWS, NEWS-C was the most accurate scoring system for predicting EDRF [AUROC 0.79 (95% CI, 0.69–0.89)] and IRS [AUROC 0.89 (95% CI, 0.82–0.96)], while NEWS 2 had the lowest accuracy in predicting EDRF [AUROC 0.59 (95% CI, 0.46–0.720)] and IRS [AUROC 0.69 (95% CI, 0.57–0.81)]. A NEWS-C ≥ 9 had a sensitivity of 59.3% and a specificity of 85.4% for predicting EDRF. For predicting IRS, a NEWS-C ≥ 9 had a sensitivity of 75% and a specificity of 88%.Conclusions: The NEWS-C was the most accurate scoring system among common EWS to identify patients with COVID-19 at risk for EDRF and need for IRS. The NEWS-C could be recommended as an early triage tool for patients with COVID-19.

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Section: Discussionsupporting

confidence: 93%

Prognostic Accuracy of Early Warning Scores for Clinical Deterioration in Patients With COVID-19

Xie

et al. 2021

Front. Med.

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“…Elderly patients present with less typical and less pronounced symptoms than younger, and and clinical risk scores should be used with caution in these patients. While the clinical scores in our study were based on the rst recorded signs after ED admission, a recently published case series of 17 patients aged ≥80 years suggest that the variability in NEWS2 scores rather than a single observation at admission could predict poor outcome [20].…”

Section: Discussionmentioning

confidence: 99%

National Early Warning Score 2 (NEWS2) on admission predicts severe disease and in-hospital mortality from Covid-19 - A prospective cohort study

Myrstad

Ihle‐Hansen

Tveita³

et al. 2020

Preprint

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Background There is a need for validated clinical risk scores to identify patients at risk of severe disease and to guide decision-making during the covid-19 pandemic. The National Early Warning Score 2 (NEWS2) is widely used in emergency medicine, but so far, no studies have evaluated its use in patients with covid-19. We aimed to study the performance of NEWS2 and compare commonly used clinical risk stratification tools at admission to predict risk of severe disease and in-hospital mortality in patients with covid-19. Methods This was a prospective cohort study in a public non-university general hospital in the Oslo area, Norway, including a cohort of all 66 patients hospitalised with confirmed SARS-CoV-2 infection from the start of the pandemic; 13 who died during hospital stay and 53 who were discharged alive. Data were collected consecutively from March 9th to April 27th 2020. The main outcome was the ability of the NEWS2 score and other clinical risk scores at emergency department admission to predict severe disease and in-hospital mortality in covid-19 patients. We calculated sensitivity and specificity with 95% confidence intervals (CIs) for NEWS2 scores ≥5 and ≥6, quick Sequential Organ Failure Assessment (qSOFA) score ≥2, ≥2 Systemic Inflammatory Response Syndrome (SIRS) criteria, and CRB-65 score ≥2. Areas under the curve (AUCs) for the clinical risk scores were compared using DeLong’s test.Results In total, 66 patients (mean age 67.9 years) were included. Of these, 23% developed severe disease. In-hospital mortality was 20%. Tachypnoea, hypoxemia and confusion at admission were more common in patients developing severe disease. A NEWS2 score ≥6 at admission predicted severe disease with 80.0% sensitivity and 84.3% specificity (Area Under the Curve (AUC) 0.822, 95% confidence interval (CI) 0.690-0.953). NEWS2 was superior to qSOFA score ≥2 (AUC 0.624, 95% CI 0.446-0.810, p<0.05) and other clinical risk scores for this purpose.Conclusion NEWS2 score at hospital admission predicted severe disease and in-hospital mortality, and was superior to other widely used clinical risk scores in patients with covid-19.

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“…However, most studies evaluate NEWS2 at admission only (10)(11)(12)(13). In the study of Sze et al, they suggested that NEWS2 score was not a valuable tool to predict clinical deterioration in elderly patients with COVID-19 (14). However, they reported the results of only 17 elderly patients.…”

Section: Early and Accurate Discrimination Of Need For Icu Improves Tmentioning

confidence: 99%

NEWS2 and laboratory predictors correlated with clinical deterioration in hospitalised patients with COVID-19

Tuncer

Sürme

Bayramlar

et al. 2021

Preprint

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BackgroundWe aimed to determine prognostic values of NEWS2 and laboratory parameters during the first week of COVID-19.MethodsAll adult patients who were hospitalized for a confirmed COVID-19 between the 11th of March and the 11th of May 2020 were retrospectively included. To evaluate the factors in prognosis which are admission to intensive care unit (ICU) and in-hospital death, univariate logistic regression analysis was performed at admission (D0), at day-3 (D3), day-5 (D5), and day-7 (D7). Additionally, receiver operating characteristic (ROC) analyses were performed.ResultsOverall, 611 patients were included. Clinical deterioration was observed in 79 (12.9%) patients during hospitalisation, 36 (5.9%) during the first three days, 54 (8.8%) during the first five days, and 62 (10.1%) during the first week of hospitalisation. Our results showed that NEWS2, procalcitonin, neutrophil/lymphocyte ratio (NLR), and albumin were the best predictors for clinical deterioration at D0, D3, D5, and D7. Procalcitonin had the highest odds ratio for clinical deterioration on all days in univariate analysis. ROC analyses showed that NEWS2 at D7, procalcitonin at D5, albumin at D7, and NLR at D5 had highest AUC values. Additionally, we detected a strong correlation between NEWS2 and laboratory parameters including neutrophil, lymphocyte, NLR, platelet/lymphocyte ratio, CRP, procalcitonin, ferritin, and urea on all days.ConclusionThis study provides a list of several laboratory parameters correlated with NEWS2 and potential predictors for ICU admission or in-hospital death during the clinical course of COVID-19. Dynamic monitoring of NEWS2 and laboratory parameters is vital for improving clinical outcomes.

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Letter to the Editor: Variability but not admission or trends in NEWS2 score predicts clinical outcome in elderly hospitalised patients with COVID-19

Cited by 24 publications

References 5 publications

Prognostic Accuracy of Early Warning Scores for Clinical Deterioration in Patients With COVID-19

Prognostic Accuracy of Early Warning Scores for Clinical Deterioration in Patients With COVID-19

National Early Warning Score 2 (NEWS2) on admission predicts severe disease and in-hospital mortality from Covid-19 - A prospective cohort study

NEWS2 and laboratory predictors correlated with clinical deterioration in hospitalised patients with COVID-19

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