Evaluation and improvement of the National Early Warning Score (NEWS2) for COVID-19: a multi-hospital study.
Evaluation and improvement of the National Early Warning Score (NEWS2) for COVID-19: a multi-hospital study.
复制标题
COVID-19 国家早期预警评分 (NEWS2) 的评估和改进：一项多医院研究
DOI：
10.1186/s12916-020-01893-3
复制
发表时间：
2021-01-21
期刊：
影响因子：
9.3
通讯作者：
Dobson RJB
中科院分区：
文献类型：
--
作者：
Carr E;Bendayan R;Bean D;Stammers M;Wang W;Zhang H;Searle T;Kraljevic Z;Shek A;Phan HTT;Muruet W;Gupta RK;Shinton AJ;Wyatt M;Shi T;Zhang X;Pickles A;Stahl D;Zakeri R;Noursadeghi M;O'Gallagher K;Rogers M;Folarin A;Karwath A;Wickstrøm KE;Köhn-Luque A;Slater L;Cardoso VR;Bourdeaux C;Holten AR;Ball S;McWilliams C;Roguski L;Borca F;Batchelor J;Amundsen EK;Wu X;Gkoutos GV;Sun J;Pinto A;Guthrie B;Breen C;Douiri A;Wu H;Curcin V;Teo JT;Shah AM;Dobson RJB
英国目前推荐使用国家预警评分（NEWS 2）对COVID-19患者进行风险分层，但对其检测重症病例的能力知之甚少。我们的目的是评估NEWS 2对严重COVID-19结果的预测，并确定和验证一组在入院时常规收集的血液和生理参数，以改善单独使用NEWS 2进行中期风险分层。培训队列包括2020年3月1日至4月30日期间因COVID-19疾病而入住国王学院医院国民健康服务（NHS）基金会信托基金的1276名患者。外部验证队列包括来自5家英国NHS信托（盖伊和圣托马斯医院、南安普顿大学医院、布里斯托大学医院和韦斯顿NHS基金会信托、伦敦大学学院医院、伯明翰大学医院）、挪威1家医院（奥斯陆大学医院）和中国武汉2家医院（武汉第六医院和泰康同济医院）的6237例患者。入院后14天，结局为严重COVID-19疾病（转入重症监护室（ICU）或死亡）。在模型中考虑了入院时测量的年龄、生理指标、血液生物标志物、性别、种族和合并症（高血压、糖尿病、心血管、呼吸系统和肾脏疾病）。“NEWS 2+年龄”的基线模型在14天时对严重COVID-19感染的区分度为差至中度（训练队列中的受试者工作特征曲线下面积（AUC）= 0.700，95%置信区间（CI）0.680，0.722; Brier评分= 0.192，95% CI 0.186，0.197）。添加了8个常规采集的血液和生理参数（补充氧流量、尿素、年龄、氧饱和度、C反应蛋白、估计肾小球滤过率、中性粒细胞计数、中性粒细胞/淋巴细胞比率）的补充模型改善了辨别力（AUC = 0.735; 95% CI 0.715，0.757），这些改善在7个英国和非英国研究中心重复。然而，有证据表明，该模型往往低估了大多数地点的风险。NEWS 2评分对中期COVID-19结果的区分度为差至中度，这引发了对其作为入院筛查工具的使用的质疑。通过纳入入院时测量的现成血液和生理参数，改善了风险分层，但有证据表明外部站点存在校准错误。这凸显了需要更好地理解COVID早期预警评分的使用。在线版本包含补充材料，可通过10.1186/s12916-020-01893-3获得。
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. 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. 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. 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. The online version contains supplementary material available at 10.1186/s12916-020-01893-3.
登录
查看更多内容
DOI：
10.1186/s13054-015-0999-1
发表时间：
2015-08-13
期刊：
Critical care (London, England)
影响因子：
--
作者：
Romero-Brufau S;Huddleston JM;Escobar GJ;Liebow M
通讯作者：
Liebow M
影响因子：
11.8
作者：
Ji, Dong;Zhang, Dawei;Qin, Enqiang
通讯作者：
Qin, Enqiang
影响因子：
9.8
作者：
Johnson AE;Pollard TJ;Shen L;Lehman LW;Feng M;Ghassemi M;Moody B;Szolovits P;Celi LA;Mark RG
通讯作者：
Mark RG
DOI：
10.1111/j.2517-6161.1995.tb02031.x
发表时间：
1995-01-01
影响因子：
5.8
作者：
BENJAMINI, Y;HOCHBERG, Y
通讯作者：
HOCHBERG, Y
影响因子：
6.7
作者：
Li, Kunhua;Wu, Jiong;Li, Chuanming
通讯作者：
Li, Chuanming