Abstract
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. A prospective study was conducted on 399 hospitalised adults with confirmed SARS-CoV-2 infection between August and December 2020. Baseline NEWS2 score was determined. Primary outcome was poor outcomes defined as need for mechanical ventilation or death within 28 days. The sensitivity, specificity and Area under the curve were determined for NEWS2 scores of 5 and 6. Mean age of patients was 55.5 ± 14.8 years and 275 of 399 (68.9%) were male. Overall mortality was 3.8% and 7.5% had poor outcomes. Median (interquartile range) NEWS2 score at admission was 2 (0-6). Sensitivity and specificity of NEWS 2 of 5 or more in predicting poor outcomes was 93.3% (95% CI: 76.5-98.8) and 70.7% (95% CI: 65.7-75.3) respectively [area under curve 0.88 (95% CI: 0.847-0.927)]. Age, baseline pulse rate, baseline oxygen saturation, need for supplemental oxygen and ARDS on chest X ray were independently associated with poor outcomes. NEWS2 score of 5 or more at admission predicts poor outcomes in patients with COVID-19 with good sensitivity and can easily be applied for risk stratification at baseline. Further studies are needed in the Indian setting to validate this simple score and recommend widespread use.
Highlights
More than a year has passed since COVID-19 was declared a pandemic
We determined the ability of National Early Warning Score 2 (NEWS2) to predict poor outcomes among adults with COVID-19
Sensitivity and specificity of NEWS 2 of 5 or more in predicting poor outcomes was 93.3% and 70.7% respectively [area under curve 0.88]
Summary
More than a year has passed since COVID-19 was declared a pandemic. While majority of SARS-CoV-2 infections are asymptomatic or mild, a small proportion develop severe disease that is often fatal despite best available care [1]. Further several laboratory parameters like the C-reactive protein, Ferritin and D-dimer have emerged as potential markers of severity [1,5,6,7], none have a definite prognostic value In other diseases such as sepsis and critical illnesses, several scoring systems have been validated for predicting poor outcomes and mortality. Some bodies have suggested the use of NEWS2 along with clinical examination to triage COVID-19 patients albeit with caution [9] Such risk stratification may help quicker decision making and enable the treating doctors to divert more attention, time and resources to those identified as high risk for fatal outcome. We determined the ability of National Early Warning Score 2 (NEWS2) to predict poor outcomes among adults with COVID-19
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