Fig 1 - available via license: Creative Commons Attribution 4.0 International
Content may be subject to copyright.
NEWS2 scoring matrix. Reproduced from: Royal College of Physicians. National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in the NHS. Updated report of a working party. London: RCP, 2017. The final score is a composite of the points for individual criteria. Higher scores (of 5 and above) usually indicate need for escalating care.
Source publication
Background
While several parameters have emerged as predictors of prognosis of COVID-19, a simple clinical score at baseline might help early risk stratification. We determined the ability of National Early Warning Score 2 (NEWS2) to predict poor outcomes among adults with COVID-19.
Methods
A prospective study was conducted on 399 hospitalised adu...
Context in source publication
Context 1
... admission, the vital signs including blood pressure, pulse, respiratory rate and oxygen saturation were recorded. The NEWS2 score was calculated on the following parameters: respiratory rate, oxygen saturation (SpO2), need for supplemental oxygen, pulse rate, level of consciousness and temperature (Fig 1). We also collected baseline laboratory investigations as part of routine COVID 19 care. ...
Citations
... National Early Warning score (NEWS2) is another tool that is simple and can be used easily by health care staff to identify high risk patients and escalate clinical care. Such stratification of risk would enable the medical team for quicker decision making and divert more attention, resources and time to those identified as high risk for fatal outcome [17]. This study had utilized the NEWS tool to predict that a score of more than 5 at admission there will be need for mechanical ventilation and may lead to mortality in COVID-19 patients. ...
Background
While several drugs are in the pipeline for treatment of various grades of COVID-19 disease, none of them have shown promise until now. Medicinal plants are crucial in developing and developed countries for their primary and basic health needs owing to better tolerability, superior compatibility with human body and having lesser side effects. Objective: To test adjuvant effect of AEV01, a patented herbal extract of kutki (Picrorhiza kurroa), in mild COVID19 in elderly patients at risk of complications and aging immunity.
Methods
A prospective, phase 3, randomized, multicentric, placebo controlled double blinded parallel group interventional trial was conducted in elderly patients aged above 50 years diagnosed as COVID-19 with mild symptoms. 70 patients were randomized into two groups to receive AEV01 capsule (100 mg) and placebo respectively thrice daily for 30 days along with standard care of treatment as per national (WHO/ICMR) guidelines in both the groups. Clinical improvement timelines and corresponding scores using 8-point ordinal scale and NEWS were assessed for efficacy and safety of AEV01 in COVID-19 patients.
Results
AEV01 group showed a significant improvement (p = 0.0001) in the normalization of the SpO2 rate and relief from cough. There was also significant difference in time to recovery, with patients in the AEV01 drug treated group recovering in 4.5 days as compared to Placebo in 9.1 days. ESR, LDH, serum ferritin, Neutrophil-Lymphocyte ratio (NLR), TNF- alpha, IL-6 and CD4 cell counts, which are considered as prognostic markers in COVID-19 infected patients, showed a significant improvement in patients treated with AEV01. The AEV01 drug treated group showed significant clinical improvement in the 8-point ordinal scale severity rating and National Early Warning Score (NEW) Score from day 3 onwards which continued up to end of study.
Conclusion
AEV01 has shown a significant improvement in clinical and laboratory parameters. There was also reduction in the progression of the COVID-19 disease in unvaccinated elderly patients from mild to moderate when treated at an earlier stage.
... NEWS 2 was analyzed at admission (D-0). 6 Clinical/laboratory parameters and WHO clinical progression scale scores were analyzed on D-0 and on days 3 (D-3), 7 (D-7), and 14 (D-14). ...
... Our findings showed that higher values of the NEWS 2 score are associated with poor outcomes in COVID-19, like a prolonged hospital stay, adverse events like septic shock and AKI, or higher in-hospital mortality. This is consistent with the findings of another Indian study done by CR et al., 6 which showed that a score of ≥5 on NEWS 2 is associated with worse outcomes. The WHO clinical progression scale showed the patient's clinical trajectory and use of resources over time with the disease course. ...
Background: Coronavirus disease 2019 (COVID-19) is majorly known to cause mild to moderate
disease, but a small fraction of patients may develop respiratory failure due to diffuse lung injury,
requiring management in the intensive care unit (ICU). This study attempts to identify factors that
can predict unfavorable outcomes in moderate to severe COVID-19 patients.
Methods: Hospital records of 120 COVID-19 patients admitted to the ICU were retrospectively
analyzed and data pertaining to demographic, clinical, and laboratory parameters were obtained.
These data were then compared with outcome parameters like survival, duration of hospital stay,
and various adverse events.
Results: Out of 120 patients, 70% were male, with a mean age of 54.44 years [standard deviation
(SD) ± 14.24 years]. Presenting symptoms included breathlessness (100%), cough (94.17%), fever
(82.5%), and sore throat (10.83%). Diabetes, hypertension, and chronic obstructive pulmonary
disease (COPD) were the common comorbidities associated. Increased serum D-dimer, ferritin,
interleukin-6 (IL-6) levels, and unvaccinated status were associated with higher mortality. Overall,
25.83% of patients survived, 24.41% of patients developed septic shock, and 10.6% of patients
were discharged on oxygen. World Health Organization (WHO) clinical progression scale score
≥ 6 had 57 and 82% sensitivity and 83 and 77% specificity on days 7 and 14 after admission,
respectively, for predicting mortality. A baseline National Early Warning Score 2 (NEWS 2) ≥ 9 had
48% sensitivity and 88% specificity for predicting mortality.
Conclusion: Advanced age and associated comorbidities are linked to adverse outcomes in
moderate to severe COVID-19. Persistently high D-dimer levels, despite standard treatment, may
also contribute to increased mortality. WHO clinical progression scale and NEWS 2 have high
specificity for predicting mortality.
... At the moment, no established method is available for early stratification of high-risk COVID-19 patients. Such risk stratification allows physicians to escalate care for potentially aggressive cases (6). The National Early Waring Score 2 (NEWS2) is a clinical tool used in ICU's to assist health care workers in stratification of highrisk septicemic patients who could be benefited by intensive management and monitoring (7). ...
... for COVID-19 patients that later required mechanical ventilation or suffered death during hospitalization (6). Contrary to some of the past studies (6,7), in present research we have documented a higher threshold value (≥6) for predicting worsening of COVID-19 infection, which coincides with NEWS2 risk levels implemented in sepsis. Our finding corroborate with a recent study conducted in neighboring India by Chikhalkar et al. (18) who found that NEWS2 score ≥6 is a statistically significant cut-off value for predicting adverse outcome on admission with 93.24% sensitivity and 98.91% specificity. ...
... The results of the present research have better external validity due to prospective and multicenter research design. We have estimated the predictive performance of discrete NEWS2 cut-offs, while most authors evaluated the predictive accuracy of a single threshold value in the COVID-19 setting (6,9). In addition, we have employed the relative risk, which is a more robust test than the odds ratio, used in past studies to determine the adverse outcomes in COVID-19 patients. ...
Aim:To validate the ability of National Early Waring Score 2 (NEWS2) for predicting the severity of Coronavirus disease-2019 (COVID-19). In addition, we also intend to examine the impact of pre-existing comorbidities to produce an advanced COVID-19 disease.Materials and Methods:A multicenter prospective cohort was performed on 108 patients having moderate-intensity COVID-19 infection during October 2020 and November 2021. NEWS2 parameters were recorded on admission to generate an output score, which then classified in accordance with the NEWS2 reference scale into low, medium, and high-risk categories. Each patient was followed till discharge or death for the clinical progression of COVID-19. The measures of validity and area under the curve (AUC) for NEWS2 threshold scores were calculated to predict the clinical deterioration of COVID-19.Results:Overall, 29.6% patients developed an advanced disease, out of which 21.8% patients died during treatment. NEWS2 score of 6 or more showed the highest sensitivity (78.1%), specificity (94.8%), and the AUC (0.838) for predicting an adverse outcome. Among comorbidities, the majority showed an increased risk of clinical deterioration.Conclusion:NEWS2 score of 6 or more at baseline showed good predictive ability to stratify patients with poor outcomes who may later require escalated care. However, we recommend more research to confirm our findings.
... This sample size was chosen for the pilot study to identify The severity of COVID-19 was assessed with early warning scores (EWS). Several studies have highlighted the impact of monitoring the prognosis of severity of an COVID-19 infection by the national early warning score and its modification national early warning score-2 (NEWS2) [34][35][36][37]. It was demonstrated that one of the best performing models to predict ICU admittance for COVID-19 patients is the NEWS2 score [37]. ...
... respectively were calculated regarding prediction of critical illness within 24 h after presentation. A NEWS2 of 5 or more at admission can prognosticate poor outcomes [35]. The recruiting site used the data collected by the Indian EWS system, which were subsequentially converted into a NEWS2 for statistical purposes. ...
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has devastated mankind. To date, no approved treatment is available to completely combat this disease. Although many studies reported the potential of silver nanoparticles’ (AgNPs) action mechanism and effect against SARS-CoV-2, this is the first clinical trial that aimed to prove this effect. This open-label, randomized, parallel-group, investigator-initiated study (IIS) was conducted in India from 2021 to 2022 and included 40 patients diagnosed with moderately-severe to severe COVID-19 pneumonia. This study proved a significantly higher survival rates (p
... 14,20 Nuestros resultados concuerdan con otros estudios realizados en diferentes países con diferente tipo de población, los cuales respaldan la utilización de la escala NEWS2 como una herramienta útil y práctica en la valoración inicial para la predicción de mortalidad, obteniendo puntos de corte de entre 5 y 7 puntos, con porcentajes de sensibilidad y especificidad superiores al 80%, similares a los encontrados en nuestra investigación. 15,21,22 También hay evidencia que demuestra que la escala REMS es útil en la predicción de mortalidad en el tipo de población en cuestión de estudio. 13,23,24 Inclusive, encontrando, en algunas series, superioridad del score REMS sobre la escala NEWS2 cuando se realizan comparaciones indirectas entre ambas escalas. ...
Background:
The prognosis and mortality in patients with COVID-19 are variable. The NEWS2 (National Early Warning Score) and REMS (Rapid Emergency Medicine Score) scales can be used quickly at hospital admission to predict mortality, no studies have been found that compare their predictive performance in our population.
Objective:
To compare NEWS2 and REMS to predict mortality in patients with COVID-19.
Material and methods:
Retrospective cohort with 361 patients. The variables were collected to calculate the NEWS2 and REMS scales and the reason for hospital discharge. The predictive value for mortality was analyzed using the ROC curve, establishing the area under the curve (AUC) with 95% confidence intervals (95% CI). The cut-off point (PC) with the best sensitivity and specificity, positive predictive value (PPV) and negative predictive value (NPV), as well as relative risk (RR) with 95% CI.
Results:
The AUC of NEWS2 and REMS were 0.929 (95% CI: 0.903-0.956) and 0.913 (95% CI: 0.884-0.943), respectively. The PC of the NEWS2 scale was 8 points, with sensitivity 87.8% and specificity 82.1%, PPV 69.7% and NPV 93.5% and of the REMS scale of 7 points, with sensitivity 83.5% and specificity 83.7%, PPV 70.5% and NPV 91.6%. 8 or more points on the NEWS2 scale presenting a RR of 10.74 (95% CI: 6.4-18.03), and REMS 7 or more points RR 8.36 (95% CI: 5.36-13.02).
Conclusion:
Both tests presented good discriminative ability to predict mortality, being better according to AUC and RR in the NEWS2 scale.
Determining the risk factors for severe disease and death among hospitalized Covid-19 patients is critical to optimize health outcomes and health services efficiency, especially in resource-constrained and humanitarian settings. This study aimed to identify the predictors of mortality of Covid-19 patients in North Kivu province in the Democratic Republic of Congo.A retrospective cohort study was conducted in 6 Covid-19 treatment centers in the city of Butembo from 1 January to 31 December 2021. The time to event (death), the outcome variable, was visualized by Kaplan-Meier curves and the log-rank test was used to confirm differences in trends. Cox regression was used for all the predictors in the bivariate analysis and multivariate analysis was done using predictors found statistically significant in the bivariate analysis. The following variables were considered for inclusion to the Cox regression model: Age, Sex, Disease length, Treatment site, History of at least one co-morbidity, Body mass index, Stage according to SpO2 and the NEWS-modified score.Among the 303 participants (mean age of 53 years), the fatality rate was 33.8 deaths per 1000 patient-days. Four predictors were independently associated with inpatient death: age category (≥ 60 years) (adjusted HR: 9.90; 95% CI: 2.68–36.27), presence of at least one comorbidity (adjusted HR: 11.39; 95% CI: 3.19–40.71); duration of illness of > 5 days before hospitalization (adjusted HR:1.70, 95% CI: 1.04–2.79) and peripheral capillary oxygen saturation (SpO2) < 90% (adjusted HR = 14.02, 95% CI: 2.23–88.32). In addition to advanced age, comorbidity, and length of disease before hospitalization, ambient air SpO2 measured by healthcare providers using low-tech, affordable and relatively accessible pulse oximetry could inform the care pathways of Covid-19 inpatients in resource-challenged health systems in humanitarian settings.
Purpose:
perform the predictive validity of National Early Warning Score 2 – Brazilian version (NEWS 2 – BR) in discharge and death outcomes in patients with COVID-19.
Methods:
cross-sectional study with predictive validity analysis. Social-demographical and clinical variables, outcomes and the score components were collected with an electronic health record and analyzed through descriptive and inferential statistics.
Outcomes:
400 patients were included, with median age of 61 years. The score, at the moment of admission, had a median of 5 points, with a range from 0 to 21. There is an association between the highest scores and the death outcome and the lowest scores and the discharge outcome. The predictive validity of NEWS 2 – BRfor death was established by the analysis of the ROC curve and the most accurate cut-off point was six points.
Conclusions:
The Brazilian version of NEWS 2 is a valid score to assess patients with COVID-19.
Aim: The emergence of a new pathogen, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in a surge of new patients requiring hospitalisation. The rapid identification of patients with severe SARS-CoV-2 infection has become a key challenge for healthcare systems. The aim of the study was to assess the prognostic value of early warning scores in predicting mortality in COVID-19 patients. Material and methods: The study involved a retrospective analysis of the medical records of 2,449 patients with COVID-19 admitted to emergency care, for whom five early warning scores were calculated based on the data obtained. Results: In order to assess the usefulness of NEWS, NEWS2, MEWS, SEWS and qSOFA in predicting in-hospital mortality in COVID-19 patients, AUC (area under the ROC curve) values were calculated. They were, respectively: 0.76 (95% CI 0.72-0.79), 0.75 (95% CI 0.72-0.79), 0.64 (95% CI 0.60-0.69), 0.61 (95% CI 0.57- 0.66) and 0.55 (95% CI 0.50-0.59). Conclusions: NEWS demonstrated the highest discriminatory power, indicating that it can be used to predict in-hospital mortality in COVID-19 patients.
Background:
Identifying COVID-19 patients at the highest risk of poor outcomes is critical in emergency department (ED) presentation. Sepsis risk stratification scores can be calculated quickly for COVID-19 patients but have not been evaluated in a large cohort.
Objective:
To determine whether well-known risk scores can predict poor outcomes among hospitalized COVID-19 patients.
Designs, settings, and participants:
A retrospective cohort study of adults presenting with COVID-19 to 156 Hospital Corporation of America (HCA) Healthcare EDs, March 2, 2020, to February 11, 2021.
Intervention:
Quick Sequential Organ Failure Assessment (qSOFA), Shock Index, National Early Warning System-2 (NEWS2), and quick COVID-19 Severity Index (qCSI) at presentation.
Main outcome and measures:
The primary outcome was in-hospital mortality. Secondary outcomes included intensive care unit (ICU) admission, mechanical ventilation, and vasopressors receipt. Patients scored positive with qSOFA ≥ 2, Shock Index > 0.7, NEWS2 ≥ 5, and qCSI ≥ 4. Test characteristics and area under the receiver operating characteristics curves (AUROCs) were calculated.
Results:
We identified 90,376 patients with community-acquired COVID-19 (mean age 64.3 years, 46.8% female). 17.2% of patients died in-hospital, 28.6% went to the ICU, 13.7% received mechanical ventilation, and 13.6% received vasopressors. There were 3.8% qSOFA-positive, 45.1% Shock Index-positive, 49.8% NEWS2-positive, and 37.6% qCSI-positive at ED-triage. NEWS2 exhibited the highest AUROC for in-hospital mortality (0.593, confidence interval [CI]: 0.588-0.597), ICU admission (0.602, CI: 0.599-0.606), mechanical ventilation (0.614, CI: 0.610-0.619), and vasopressor receipt (0.600, CI: 0.595-0.604).
Conclusions:
Sepsis severity scores at presentation have low discriminative power to predict outcomes in COVID-19 patients and are not reliable for clinical use. Severity scores should be developed using features that accurately predict poor outcomes among COVID-19 patients to develop more effective risk-based triage.
