Performance Analysis of the National Early Warning Score and Modified Early Warning Score in the Adaptive COVID-19 Treatment Trial Cohort.
Performance Analysis of the National Early Warning Score and Modified Early Warning Score in the Adaptive COVID-19 Treatment Trial Cohort.
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DOI：
10.1097/cce.0000000000000474
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发表时间：
2021-07-01
影响因子：
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通讯作者：
Liang, C Jason
中科院分区：
文献类型：
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作者：
Colombo, Christopher J;Colombo, Rhonda E;Liang, C Jason
我们试图验证2019年冠状病毒病的预后评分，包括国家预警评分，修正的预警评分和基于年龄的修正，并定义其性能特征。设计：我们分析了前瞻性收集的自适应COVID-19治疗试验的数据。在试验期间每天收集国家预警评分，计算改良预警评分，并将年龄应用于两个评分。我们评估了恢复、机械通气和死亡终点的预后价值，包括入组时的评分、平均评分和最初48小时内的评分斜率。适应性COVID-19治疗试验1随机分配参与者接受Remdesivir或安慰剂。预测评分的预后价值分别在两组中进行评估，以评估在remdesivir treatment.MEASUREMENTS和主要结果的设置中的差异性能：对于死亡率，基线国家预警评分和修改的预警评分弱至中度预后（c-指数，0.60-0.68），并改善与年龄（c-指数，0.66-0.74）。对于恢复，基线国家预警评分和改良的预警评分显示出更好的预后能力（c指数，0.65-0.69）;然而，国家预警评分+年龄和改良的预警评分+年龄进一步改善了性能（c指数，0.68-0.71）。对于恶化，基线国家预警评分和改良预警评分为弱至中度预后（c指数，0.59-0.69），并随年龄增加而改善（c指数，0.63-0.70）。由于年龄的增加，所有预后表现的改善都是显著的（p < 0.05）。结论：在适应性COVID-19治疗试验1队列中，国家预警评分和改良预警评分在2019年严重冠状病毒病患者中表现出中等预后表现，国家预警评分+年龄和改良预警评分+年龄的预测能力有所改善。与安慰剂相比，在大流行早期接受Remdesivir治疗的患者的国家早期预警评分和改良早期预警评分的受试者工作曲线下面积在恢复和死亡率方面有所改善。尽管这些评分很简单，在各种情况下都很容易获得，但在我们的数据集中，它们的预测性不足以完全取代2019年冠状病毒疾病的临床判断，最好是作为分流、处置和资源决策的辅助工具。
We sought to validate prognostic scores in coronavirus disease 2019 including National Early Warning Score, Modified Early Warning Score, and age-based modifications, and define their performance characteristics.DESIGN: We analyzed prospectively collected data from the Adaptive COVID-19 Treatment Trial. National Early Warning Score was collected daily during the trial, Modified Early Warning Score was calculated, and age applied to both scores. We assessed prognostic value for the end points of recovery, mechanical ventilation, and death for score at enrollment, average, and slope of score over the first 48 hours.SETTING: A multisite international inpatient trial.PATIENTS: A total of 1,062 adult nonpregnant inpatients with severe coronavirus disease 2019 pneumonia.INTERVENTIONS: Adaptive COVID-19 Treatment Trial 1 randomized participants to receive remdesivir or placebo. The prognostic value of predictive scores was evaluated in both groups separately to assess for differential performance in the setting of remdesivir treatment.MEASUREMENTS AND MAIN RESULTS: For mortality, baseline National Early Warning Score and Modified Early Warning Score were weakly to moderately prognostic (c-index, 0.60-0.68), and improved with addition of age (c-index, 0.66-0.74). For recovery, baseline National Early Warning Score and Modified Early Warning Score demonstrated somewhat better prognostic ability (c-index, 0.65-0.69); however, National Early Warning Score+age and Modified Early Warning Score+age further improved performance (c-index, 0.68-0.71). For deterioration, baseline National Early Warning Score and Modified Early Warning Score were weakly to moderately prognostic (c-index, 0.59-0.69) and improved with addition of age (c-index, 0.63-0.70). All prognostic performance improvements due to addition of age were significant (p < 0.05).CONCLUSIONS: In the Adaptive COVID-19 Treatment Trial 1 cohort, National Early Warning Score and Modified Early Warning Score demonstrated moderate prognostic performance in patients with severe coronavirus disease 2019, with improvement in predictive ability for National Early Warning Score+age and Modified Early Warning Score+age. Area under receiver operating curve for National Early Warning Score and Modified Early Warning Score improved in patients receiving remdesivir versus placebo early in the pandemic for recovery and mortality. Although these scores are simple and readily obtainable in myriad settings, in our data set, they were insufficiently predictive to completely replace clinical judgment in coronavirus disease 2019 and may serve best as an adjunct to triage, disposition, and resourcing decisions.