National Early Warning Score 2 (NEWS2) on admission predicts severe disease and in-hospital mortality from Covid-19-a prospective cohort study
National Early Warning Score 2 (NEWS2) on admission predicts severe disease and in-hospital mortality from Covid-19-a prospective cohort study
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DOI：
10.1186/s13049-020-00764-3
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发表时间：
2020-07-13
影响因子：
3.3
通讯作者：
Berge, Trygve
中科院分区：
文献类型：
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作者：
Myrstad, Marius;Ihle-Hansen, Hakon;Berge, Trygve
背景 需要经过验证的临床风险评分来识别有严重疾病风险的患者，并在 covid-19 大流行期间指导决策。国家早期预警评分 2 (NEWS2) 广泛应用于急诊医学，但到目前为止，还没有研究评估其在 covid-19 患者中的使用。我们的目的是研究 NEWS2 的性能，并比较入院时常用的临床风险分层工具，以预测 covid-19 患者的严重疾病风险和院内死亡率。方法 这是在挪威奥斯陆地区一家公立非大学综合医院进行的一项前瞻性队列研究，包括从大流行开始以来住院确诊的 SARS-CoV-2 感染的所有 66 名患者； 13人在住院期间死亡，53人活着出院。数据于2020年3月9日至4月27日连续收集。主要结果是急诊科入院时NEWS2评分和其他临床风险评分预测covid-19患者重症和院内死亡率的能力。我们使用 95% 置信区间 (CI) 计算 NEWS2 评分 >= 5 和 >= 6、快速序贯器官衰竭评估 (qSOFA) 评分 >= 2、>= 2 全身炎症反应综合征 (SIRS) 标准以及 CRB-65 评分 >= 2 的敏感性和特异性。使用 DeLong 检验比较临床风险评分的曲线下面积 (AUC)。结果 总共纳入 66 名患者（平均年龄 67.9 岁）。其中，23% 出现严重疾病。院内死亡率为20%。入院时呼吸急促、低氧血症和精神错乱在病情严重的患者中更为常见。入院时 NEWS2 评分 >= 6 预测严重疾病，敏感性为 80.0%，特异性为 84.3%（曲线下面积 (AUC) 0.822，95% CI 0.690-0.953）。为此目的，NEWS2 优于 qSOFA 评分 >= 2（AUC 0.624，95% CI 0.446-0.810，p < 0.05）和其他临床风险评分。结论 入院时 NEWS2 评分可以预测 covid-19 患者的严重疾病和院内死亡率，并且优于其他广泛使用的临床风险评分。
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% 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.