Performance of NEWS, qSOFA, and SIRS Scores for Assessing Mortality, Early Bacterial Infection, and Admission to ICU in COVID-19 Patients in the Emergency Department.

Julio Alencar,Heraldo Possolo De Souza,Luz Marina Gómez Gómez,Andre Lazzeri Cortez,Anna Sara Levin,Matias Chiarastelli Salomão

doi:10.3389/fmed.2022.779516

Abstract

SARS-CoV-2 infection has a wide spectrum of presentations, from asymptomatic to pneumonia and sepsis. Risk scores have been used as triggers for protocols that combine several interventions for early management of sepsis. This study tested the accuracy of the score SIRS, qSOFA, and NEWS in predicting outcomes, including mortality and bacterial infection, in patients admitted to the emergency department (ED) during the COVID-19 pandemic. We described 2,473 cases of COVID-19 admitted to the ED of the largest referral hospital for severe COVID-19 in Brazil during the pandemic. SIRS, qSOFA and NEWS scores showed a poor performance as prognostic scores. However, NEWS score had a high sensitivity to predict in-hospital death (0.851), early bacterial infection (0.851), and ICU admission (0.868), suggesting that it may be a good screening tool for severe cases of COVID-19, despite its low specificity.

Highlights

SARS-CoV-2 infection has a wide spectrum of presentations, from asymptomatic to severe cases of viral pneumonia and Acute Respiratory Distress Syndrome [1]
In this study we described 2.473 cases of COVID-19 admitted to the emergency department of a tertiary hospital during the pandemic, in order to evaluate the performance of SIRS, qSOFA and NEWS scores to predict in-hospital mortality, early bacterial infection, and intensive care unit (ICU) admission
Our findings suggest a poor performance of the 3 prognostic scores

Summary

Introduction

SARS-CoV-2 infection has a wide spectrum of presentations, from asymptomatic to severe cases of viral pneumonia and Acute Respiratory Distress Syndrome [1]. Considering the pathophysiology and the clinical manifestations, some COVID-19 patients meet the definition of sepsis, described as an unregulated inflammatory host response to infection that results in organ failure and risk of death [2, 3]. This concept of sepsis is recent and was updated after a better understanding of pathophysiological events [4]. In a consensus definition from 1991, sepsis was defined as a systemic inflammatory response (SIRS—Systemic Inflammatory Response Syndrome) caused by infection [5, 6]. The diagnosis of sepsis was made in patients with suspected or confirmed infection and two of four criteria: abnormalities in body temperature, tachypnea, tachycardia and leukocytosis [6].

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Conclusion