NEWS2 Score Research Articles

C-Reactive Protein Levels during High Dose Steroid Treatment for COVID-19 Pneumonia

Objectives: Inflammation is the main cause of systemic damage in SARS-COV2 infections. Steroid treatment has been shown to reduce mortality in COVID-19. However, there is no index to monitor treatment responses to steroids. Here, we evaluated the validity of serial C-reactive-protein (CRP) follow-up for predicting the outcome in the patients receiving steroid therapy. Material and methods: In our retrospective cohort study, four hundred twenty-five patients were included. All patients received dexamethasone 6 mg/day or equivalent dose of steroid as much as needed with the onset of hypoxia (SaO2 ≤ 93%). We divided patients into two groups according to outcome (deceased/discharged). We then compared demographic, clinical and laboratory features between the groups. Lastly, we evaluated the thresholds of CRP decline associated with COVID-19 associated mortality at 3th, 5th days and at the end of treatment. Results: COVID 19 associated mortality rate of the cohort was 6.1% (26/425). In multivariate analysis, in which survival was evaluated, parameters related to death due to COVID-19 in the steroid group were high NEWS-2 score (0.82, CI 95 % 0.68-0.97, p=0.02), increased Charlson comorbidity index (0.68,CI 95% 0.51-0.90,p= 0.007) and absolute CRP level at the end of treatment (0.97,CI 95%, p<0.001). In addition, cut-off levels of CRP reduction related to COVID-19-associated mortality during steroid therapy were found as follows: less than 33% (sensitivity 75%, specificity 64.1%) on day 3, less than 43.5% (sensitivity 81.8%, specificity 70.8%) on day 5 and less than 55% at the end of the treatment (sensitivity 80.7%, specificity 71.8%). Conclusions: Serial CRP measurement from the third day of steroid therapy can be used to predict mortality in COVID-19 patients receiving steroids.

Acil Serviste Ciddi COVID-19 Vakalarında Kullanılan Risk Puanlama Sistemlerinin Performansı

Objective: The aim of this study is to evaluate the performance of CURB-65, Quick Sequential Organ Failure Assessment (qSOFA), and National Early Warning Score 2 (NEWS 2) scores in predicting mortality in COVID-19 patients in emergency department.
 Method: A total of 502 patients diagnosed with severe COVID-19 in the emergency department of a pandemic hospital were analyzed retrospectively. Demographic, clinical and laboratory data of the patients were obtained from the hospital registry system. The CURB-65, qSOFA, and NEWS2 scores of each patient were calculated separately. These patients were divided into two groups as those who survived and those who died. All parameters and calculated risk scores were statistically compared between these two groups.
 Results: While 281 out of 502 patients survived, 221 died. When the CURB-65, NEWS2, qSOFA scores were compared between the two patient groups, a significant difference was found (p

Utility of Walk Tests in the Progression of Mild COVID-19 Infection at a Tertiary Hospital in North India.

There have been 214 million confirmed cases of COVID-19 worldwide, with a total death tally of 4.4 million. The current study aims to determine the predictive value of various scores in the assessment of progression of mild COVID-19 infection at a tertiary care hospital in North India. The study population consisted of adults (age more than 18 years) with a confirmed diagnosis of COVID-19 by RT-PCR on nasopharyngeal specimens. Patients with only mild illness were enrolled. After the patients were admitted to the isolation ward, the presenting history, comorbidity status, vital signs and laboratory parameters were recorded. The 3 and 6 minutes walk test was performed daily from admission till discharge or progression of the severity of COVID- 19, and it was used to calculate Borg Dyspnoea Score (BDS) and National Early Warning Score (NEWS2) scores. Our study consisted of 50 patients with 34 (68%) males, and the mean (SD) age of the patient population was 28.1 (6.4) years. The most common symptoms were fever, sore throat, and cough. All laboratory parameters were within normal ranges for all the patients. 96% recovered without progression, while only 4% of them progressed to moderate illness. Results of the 3 and 6 minutes walk tests, BDS and NEWS2 scores showed improvement over the course of the hospital stay. Although the walk tests and the scores improved over time, they failed to predict the disease progression.

Hemoadsorption in Patients with Various Types of Respiratory Support for Severe COVID-19

Study aim. To evaluate the efficacy of hemoadsorption in patients with severe COVID-19 on mechanical lung ventilation (MLV) and noninvasive respiratory support.Material and methods. We retrospectively analysed longitudinal clinical and laboratory parameters of 49 patients with severe coronavirus infection who were treated in the First Intensive care unit of Grodno University Hospital from September 2020 to November 2021 and underwent hemoadsorption using the Hemo-Proteasosorb sorbent. All patients were divided into two groups: Hemo-Proteasosorb + MLV (22 patients who underwent hemoadsorption while being on MLV) and Hemo-Proteasosorb without MLV (27 patients who had hemoadsorption while receiving the low- and high-flow oxygen therapy or noninvasive lung ventilation).Results. In the Hemo-Proteasosorb + MLV group a decrease in procalcitonin (PCT) (from 0.27 [0.12–2.08] down to 0.14 [0.05–1.77], P=0.027), C-reactive protein (CRP) (from 135.4 [10.6–303.0] down to 64.3 [1.2–147.0], P=0.003), fibrinogen (from 11.7 [4.9–19.49] to 8.2 [3.7–14.7], P=0.00004), and D-dimer (from 1432.0 [443.0–6390.0] to 1087.0 [415.0–3247.0], P=0.006) was seen on day 3 after the hemoadsorption session. The Hemo-Proteasosorb without MLV group also demonstrated a reduction in the levels of CRP (from 4 [10.6–303.0] to 64.3 [1.2–147.0], P=0.003), fibrinogen (from 11.7 [4.9–19.49] to 8.2 [3.7–14.7], P=0.00004), D-dimer (from 1432.0 [443.0–6390.0] to 1087.0 [415.0–3247.0], P=0.006) on day 3 after the hemoadsorption session. The Hemo-Proteasosorb without MLV group also showed a decrease in PCT (from 0.29 [0.14–21.25] to 0.14 [0.04–11.91], P=0.002), CRP (from 132.6 [30.7–183.0] to 28.55 [5.3–182.0], P=0.0002), fibrinogen (from 10.2 [4.41–15.5] to 6.5 [2.8–11.9], P=0.00005), D-dimer (from 1445.0 [365.0–4830.0] to 1049.0 [301.0–3302.0], P=0.005), while an increase in SpO₂/FiO₂ (from 238 [88–461] up to 320 [98–471], P=0.011) was registered. On days 5–7, positive changes in SpO₂/FiO₂ index (238 [88–461] vs 320 [96–471], P=0.0020) were observed in the Hemo-Proteasosorb without MLV group, as well as a trend toward further reduction in the levels of CRP (132.6 [30.7–183.0] vs 23.85 [2.2–200.0], P=0.0001) and fibrinogen (10.2 [4.41–15.5] to 5.11 [2.3–11.5], P=0.0017). The patients were assessed using the NEWS2 score at all the stages of the study. On days 2–3 of the study, a reduction in the mean NEWS2 score was noted in the Hemo-Proteasosorb + MLV group (8.0 [4.0–11.0] vs 6.0 [2.0–10.0], P=0.0002), whereas on days 5–7 its increase was seen vs stage 2 of the study with its values still lower than those prior to hemoadsorption (8.0 [4.0–11.0] vs 7.0 [2.0–9.0], P=0.011). On day 3 of treatment, in the Haemo-Proteasorb without MLV group we observed a decreased mean NEWS2 score (7.0 [3.0–9.0] vs 5.0 [1.0–9.0], P=0.00002), on days 5–7, this trend was still present (7.0 [3.0–9.0] vs 3.0 [1.0–8.0], P=0.00002).Conclusion. Hemoadsorption was beneficial for patients with severe COVID-19 during both oxygen therapy and mechanical ventilation due to decreased levels of inflammatory markers, hypercoagulation, and reduced NEWS2 scores.

Development of the PREDS score to predict in-hospital mortality of patients with Ebola virus disease under advanced supportive care: Results from the EVISTA cohort in the Democratic Republic of the Congo.

SummaryBackgroundAs mortality remains high for patients with Ebola virus disease (EVD) despite new treatment options, the ability to level up the provided supportive care and to predict the risk of death is of major importance. This analysis of the EVISTA cohort aims to describe advanced supportive care provided to EVD patients in the Democratic Republic of the Congo (DRC) and to develop a simple risk score for predicting in-hospital death, called PREDS.MethodsIn this prospective cohort (NCT04815175), patients were recruited during the 10th EVD outbreak in the DRC across three Ebola Treatment Centers (ETCs). Demographic, clinical, biological, virological and treatment data were collected. We evaluated factors known to affect the risk of in-hospital death and applied univariate and multivariate Cox proportional-hazards analyses to derive the risk score in a training dataset. We validated the score in an internal-validation dataset, applying C-statistics as a measure of discrimination.FindingsBetween August 1st 2018 and December 31th 2019, 711 patients were enrolled in the study. Regarding supportive care, patients received vasopressive drug (n = 111), blood transfusion (n = 101), oxygen therapy (n = 250) and cardio-pulmonary ultrasound (n = 15). Overall, 323 (45%) patients died before day 28. Six independent prognostic factors were identified (ALT, creatinine, modified NEWS2 score, viral load, age and symptom duration). The final score range from 0 to 13 points, with a good concordance (C = 86.24%) and calibration with the Hosmer-Lemeshow test (p = 0.12).InterpretationThe implementation of advanced supportive care is possible for EVD patients in emergency settings. PREDS is a simple, accurate tool that could help in orienting early advanced care for at-risk patients after external validation.FundingThis study was funded by ALIMA.

CN54 The implementation of NEWS2 Score in oncology patients and nursing handover with SBAR method: A pilot study

In the last decades several clinical learning models are beeing used for nursing education, these are finalized to activate the learning process from the internship experiences. The implementation of new evidence-based tools for patient safety, as the vital signs NEWS2 score, which is used for “Early Warning” in patient at risk of clinical deterioration, and the new models of nursing handover as the SBAR method are easier to implement when they are preceded by nursing students during a clinical learning.

TU8.11 Improving the efficiency of the EGS service in a University Teaching Hospital. Smarter application of standards and use of resources

Abstract Aim Effective utilization of resources for emergency general surgery (EGS) is essential for operational efficiency. Many patients have pathology with a time-dependent outcome and clinical standards have been established regarding timing of surgical intervention. The aim of this study was to investigate barriers to the delivery of timely EGS. Methods The delivery of EGS between 31/01/21 and 30/08/21 was studied. All cases were reviewed to determine clinical urgency, appropriateness of “urgency” within the clinical context (diagnosis, NEWS-2 score) and timing of EGS. Discrepancies between theatre booking and clinical need and delay in undertaking EGS compared with the relevant clinical standards were identified. Results EGS was undertaken in 520 patients (262M:258 F), mean age 49 (16–101) years. 34(6%) were booked as needing “immediate”, 130 (25%) “urgent 2–6hr”, 242 (47%) “urgent 6–18 hr” and 114 (22%) “expedited” EGS. In 373 (71.7%), EGS was undertaken in a time frame which met (or exceeded) relevant standards. In 235 (45%) cases, the urgency of booking exaggerated clinical need. EGS was “delayed” in 147 (28.3%) cases when compared with urgency as booked, but when actual clinical need was reviewed EGS was delayed in only 66 cases (12.7%). Delay was due to unavailability of facilities in 25 (38%) of cases, whereas in 24 (36%) treatment was delayed purely “overnight”. Conclusion Inappropriate allocation of clinical urgency resulted in the majority of “delayed” EGS. The routine application of RCS18 standards would prevent this. Avoiding delay overnight and an increase in theatre resource would improve efficiency.

Better prognostic ability of NEWS2, SOFA and SAPS-II in septic patients

Background and objectivesTo compare the ability of qSOFA, NEWS2, SOFA, LODS, SIRS, APACHE-II and SAPS-II scores. Material and methodsAnalysis of in-hospital mortality of 203 patients admitted to the ICU because of sepsis. The scores were compared according to their application. Discrimination was evaluated with AUC-ROC curve and performance with the Akaike’s (AIC) and Bayesian Information criterion (BIC). ResultsIn-hospital mortality was 31.53%. NEWS2 showed better mortality discrimination ability and better performance considering the AIC/BIC criterion for mortality tan qSOFA (AUC-ROC = 0.615 and 0.536, P = .039). SOFA presented higher performance and AUC-ROC tan LODS (0.776 vs. 0.693, P = .01) and both showed higher discrimination ability than SIRS (AUC-ROC = 0.521, P < .003). Finally, SAPS-II was able to predict mortality with better performance than APACHE-II and presented higher discrimination capacity but without statistical significance compared (AUROC = 0.738 for SAPS-II and AUROC = 0.673 for APACHE-II, P = .08). ConclusionNEWS2 is a better predictor of mortality than qSOFA and its implementation for the early recognition of the septic patient or the patient with higher risk in the emergency and hospitalization wards should be addressed. In addition, given that SOFA and SAPS-II showed better performance and are simpler than LODS and APACHE-II, respectively, both should be considered the scores of choice in this setting.

Ferritin as a predictive biomarker of severity in Covid-19

To prevent the crisis-level shortage of beds in hospitals and for a more efficient support, it’s necessary to early identify coronavirus disease-19 (Covid-19) patients at risk to develop a severe form of the disease. The goal of our study was to determine whether biological markers, including the serum ferritin, could predict the severity of the Covid-19. One hundred and seventy-one patients, who were admitted to Caen University Hospital, were included retrospectively with a positive diagnosis of Covid-19 by RT-PCR. A serum ferritin measurement was performed for all patients. They were further classified either into a non-severe or a severe group based on their hospitalization in intense care unit (ICU) for mechanical ventilation or death. Univariate analysis revealed a significant association between increased serum ferritin and CRP levels, obesity, CT scan lesions, pathological respiratory rate, decreased PaO2/FiO2 ratio, the NEWS-2 score and the severe (n = 59) vs the non-severe (n = 112) outcome of Covid-19 patients. However, in a multivariate analysis, only CRP and obesity were associated with the severe form of Covid-19. While pathological level of serum ferritin at admission is associated with severe form of Covid-19, combination of increased CRP level and obesity would better predict the severity of the disease.

Real-World Effectiveness and Optimal Dosage of Favipiravir for Treatment of COVID-19: Results from a Multicenter Observational Study in Thailand.

Favipiravir is a broad-spectrum oral antiviral agent that shows in vitro activity against SARS-CoV-2. Presently, data on the real-world effectiveness and optimal dosage of favipiravir for treating COVID-19 are limited. We conducted a retrospective observational study of hospitalized adult patients with COVID-19 at five tertiary care hospitals in Thailand. We reviewed patient charts to obtain all necessary data. Among 247 COVID-19 patients, 63 (23.0%) received ≥1 dose of favipiravir. Of these 63 patients, 61.9% were male with a median age of 48 years (range 22–85 years), 27.0% required an O2 nasal cannula, 9.5% required non-invasive ventilation and/or high-flow O2 therapy, and 6.4% required invasive mechanical ventilation and/or ECMO. The median baseline NEWS2 score was 5 (0–16). The Day-7 clinical improvement rate [95%CI] was 66.7% [53.7–78.0%] in all patients, 92.5% [75.7–99.1%] in patients who did not require O2 supplementation, and 47.2% [0.4–64.5%] in patients who required O2 supplementation. No life-threatening adverse events were identified. The 28-day mortality rate was 4.8%. A multivariate analysis revealed three poor prognostic factors for Day-7 clinical improvement (odds ratio (95%CI); p-value): older age (0.94 (0.89–0.99); p = 0.04), a higher baseline NEWS2 score (0.64 (0.47–0.88); p = 0.006), and a lower favipiravir loading dose (≤45 mg/kg/day) (0.04 (0.005–0.4); p = 0.006). In conclusion, our study reports the promising effectiveness of favipiravir for treating COVID-19 patients. In addition to older age and a high baseline NEWS2 score, a low loading dose of favipiravir (≤45 mg/kg/day) was also identified as a poor prognostic factor for early clinical improvement. Further studies to explore the optimal dose and the optimal timing of drug initiation for favipiravir should be performed.

Double-Blind, Randomized, Placebo-Controlled Study on hzVSF-v13, a Novel Anti-Vimentin Monoclonal Antibody Drug as Add-on Standard of Care in the Management of Patients with Moderate to Severe COVID-19.

Humanized Virus Suppressing Factor-variant 13 (hzVSF-v13), a monoclonal IgG4 antibody against vimentin, was investigated in moderate to severe COVID-19 pneumonia through a Phase II study. Patients were randomized to two different IV doses of the test drug or saline with standard of care. Overall, 64 patients were recruited, and 62 entered the efficacy assessment in the full analysis set. Primary endpoint: The clinical failure rate at day 28 was 15.8% for placebo, 9.1% for low-dose hzVSF-v13 and 9.5% for high-dose hzVSF-v13 (not significant). A trend toward better efficacy was shown in several secondary endpoints, with statistical significance between low-dose hzVSF-v13 and placebo in terms of the rate of improved patients on the ordinal scale for clinical improvement (OSCI): 90.0% vs. 52.63% (p = 0.0116). In the severe stratum, the results of low-dose hzVSF-v13 vs. placebo were 90.0% and 22.2% for OSCI (p = 0.0092), 9 days and 14 days for time to discontinuation of oxygen therapy (p = 0.0308), 10 days and 15 days for both time to clinical improvement (TTCI) and time to recovery (TTR) and p = 0.0446 for both TTCI and TTR. Change from baseline of NEWS2 score at day 28 was −3.4 vs. + 0.4 (p = 0.0441). The results propose hzVSF-v13 as a candidate in the treatment of severe COVID-19.

Predictive Value of Sequential Organ Failure Assessment, Quick Sequential Organ Failure Assessment, Acute Physiology and Chronic Health Evaluation II, and New Early Warning Signs Scores Estimate Mortality of COVID-19 Patients Requiring Intensive Care Unit.

IntroductionVarious mortality predictive score models for coronavirus disease-2019 (COVID-19) have been deliberated. We studied how sequential organ failure assessment (SOFA), quick sequential organ failure assessment (qSOFA), acute physiology and chronic health evaluation II (APACHE II), and new early warning signs (NEWS-2) scores estimate mortality in COVID-19 patients.Materials and methodsWe conducted a prospective cohort study of 53 patients with moderate-to-severe COVID-19. We calculated qSOFA, SOFA, APACHE II, and NEWS-2 on initial admission and re-evaluated on day 5. We performed logistic regression analysis to differentiate the predictors of qSOFA, SOFA, APACHE II, and NEWS-2 scores on mortality.ResultqSOFA, SOFA, APACHE II, and NEWS-2 scores on day 5 exhibited a difference between survivors and nonsurvivors (p <0.05), also between ICU and non-ICU admission (p <0.05). The initial NEWS-2 revealed a higher AUC value than the qSOFA, APACHE II, and SOFA score in estimating mortality (0.867; 0.83; 0.822; 0.794). In ICU, APACHE II score revealed a higher AUC value than the SOFA, NEWS-2, and qSOFA score (0.853; 0.832; 0.813; 0.809). Concurrently, evaluation on day 5 showed that qSOFA AUC had higher scores than the NEWS-2, APACHE II, and SOFA (0.979; 0.965; 0.939; 0.933) in predicting mortality, while SOFA and APACHE II AUC were higher in ICU admission than NEWS-2 and qSOFA (0.968; 0.964; 0.939; 0.934). According to the cutoff score, APACHE II on day 5 revealed the highest sensitivity and specificity in predicting the mortality (sensitivity 95.7%, specificity 86.7%).ConclusionAll scores signify good predictive values on COVID-19 patients mortality following the evaluation on the day 5. Nonetheless, APACHE-II appears to be the best at predicting mortality and ICU admission rate.How to cite this articleAsmarawati TP, Suryantoro SD, Rosyid AN, Marfiani E, Windradi C, Mahdi BA, et al. Predictive Value of Sequential Organ Failure Assessment, Quick Sequential Organ Failure Assessment, Acute Physiology and Chronic Health Evaluation II, and New Early Warning Signs Scores Estimate Mortality of COVID-19 Patients Requiring Intensive Care Unit. Indian J Crit Care Med 2022;26(4):464–471.

A New Early Predictor of Fatal Outcome for COVID-19 in an Italian Emergency Department: The Modified Quick-SOFA.

Background: Since 2019, the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is causing a rapidly spreading pandemic. The present study aims to compare a modified quick SOFA (MqSOFA) score with the NEWS-2 score to predict in-hospital mortality (IHM), 30-days mortality and recovery setting. Methods: All patients admitted from March to October 2020 to the Emergency Department of St. Anna Hospital, Ferrara, Italy with clinically suspected SARS-CoV-2 infection were retrospectively included in this single-centre study and evaluated with the MqSOFA and NEWS-2 scores. Statistical and logistic regression analyses were applied to our database. Results: A total of 3359 individual records were retrieved. Among them, 2716 patients were excluded because of a negative nasopharyngeal swab and 206 for lacking data; thus, 437 patients were eligible. The data showed that the MqSOFA and NEWS-2 scores equally predicted IHM (p < 0.001) and 30-days mortality (p < 0.001). Higher incidences of coronary artery disease, congestive heart failure, cerebrovascular accidents, dementia, chronic kidney disease and cancer were found in the deceased vs. survived group. Conclusions: In this study we confirmed that the MqSOFA score was non-inferior to the NEWS-2 score in predicting IHM and 30-days mortality. Furthermore, the MqSOFA score was easier to use than NEWS-2 and is more suitable for emergency settings. Neither the NEWS-2 nor the MqSOFA scores were able to predict the recovery setting.

Novel biomarker-based score (SAD-60) for predicting mortality in patients with COVID-19 pneumonia: a multicenter retrospective cohort of 1013 patients.

Background: The aim was to explore a novel risk score to predict mortality in hospitalized patients with COVID-19 pneumonia. Methods: This was a retrospective, multicenter study. Results: A total of 1013 patients with COVID-19 were included. The mean age was 60.5 ± 14.4 years, and 581 (57.4%) patients were male. In-hospital death occurred in 124 (12.2%) patients. Multivariate analysis revealed peripheral capillary oxygen saturation (SpO2), albumin, D-dimer and age as independent predictors. The mortality score model was given the acronym SAD-60, representing SpO2, Albumin, D-dimer, age ≥60 years. The SAD-60 score (0.776) had the highest area under the curve compared with CURB-65 (0.753), NEWS2 (0.686) and qSOFA (0.628) scores. Conclusion: The SAD-60 score has a promising predictive capacity for mortality in hospitalized patients with COVID-19.

Interim Analysis of Impact of Adding Low Dose Pulmonary Radiotherapy to Moderate COVID-19 Pneumonia Patients: IMpaCt-RT Study.

BackgroundTreatment for coronavirus disease 2019 (COVID-19) pneumonia remains largely supportive till date and multiple clinical trials took place within the short span of time to evaluate the role of investigational therapies. The anti-inflammatory effect of low dose whole lung radiation in treating pneumonia has been documented earlier. This clinical trial analyzed the effect of low dose radiation therapy (LDRT) in a moderately affected COVID-19 pneumonia patient cohort and has evaluated its effect in stopping the conversion of moderate disease into severe disease.MethodsPatients with moderate COVID-19 pneumonia as characterized by the Ministry of Health and Family Welfare (MOHFW), Government of India, were randomized (1:1) to low dose whole lung radiation versus no radiation. All treatment of patients was concurrently being given as per institutional protocol. Patients were followed up with clinical and laboratory parameters monitored on Days 1, 3, 7, and 14. Computed tomography scan (CT scan) of thorax was performed on Days 1 and 7. Patients were evaluated for conversion of moderate into severe disease as per National Early Warning Score-2 (NEWS-2 score) as the primary end point. The secondary endpoints included changes in ratio between peripheral capillary oxygen saturation and fraction of inspired oxygen (SpO2/FiO2), biochemical markers, 25-point CT severity score, and radiation induced acute pulmonary toxicities.FindingsAt the interim analysis, there were seven patients in the radiation arm and six in the control. A whole lung LDRT improved the outcome of SpO2/FiO2 at Day 3; however it did not convert into a statistically significant improvement for the NEWS-2 score. The serum levels of LDH, CRP, Ferritin and D-dimer were significantly reduced on 14 days in the LDRT arm in comparison to the baseline value but were not significant between the two groups.InterpretationLDRT seems to have the potential to prevent moderate COVID-19 pneumonia from a deteriorating to severe category. However, further randomized clinical trial with an adequate number of such patients is warranted to establish the definitive role of LDRT in the management of COVID-19 pneumonia.FundingAn intramural research project bearing code: I-27/621, was sanctioned from the All India Institute of Medical Sciences, Patna, India.Clinical Trial RegistrationClinical Trials Registry-India (CTRI/2021/06/033912, 25th May 2021) ctri.nic.in/Clinicaltrials/login.php

Chest X-ray Severity Score as a Putative Predictor of Clinical Outcome in Hospitalized Patients: An Experience From a Vietnamese COVID-19 Field Hospital.

BackgroundThrough the coronavirus disease 2019 (COVID-19) pandemic, portable radiography was particularly useful for assessing and monitoring the COVID-19 disease in Vietnamese field hospitals. It provides a convenient and precise picture of the progression of the disease. The purpose of this study was to evaluate the predictive value of chest radiograph reporting systems (Brixia and total severity score (TSS)) and the National Early Warning Score (NEWS) clinical score in a group of hospitalized patients with COVID-19.MethodsThis retrospective cohort study used routinely collected clinical data from polymerase chain reaction (PCR)-positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients admitted to Field Hospital District 8, Ho Chi Minh City, Vietnam, from August 2021 to September 2021. The initial chest radiographs were scored based on the TSS and Brixia scoring systems to quantify the extent of lung involvement. After the chest radiograph score was reported, two residents calculated the rate of all-cause in-hospital mortality with the consultation of expert radiologists. In this study, NEWS2 scores on hospital admission were calculated. The gradient boosting machines (GBMs) and Shapley additive exPlanations (SHAP) were applied to access the important variable and improve the accuracy of mortality prediction. The adjusted odds ratio for predictor was presented by univariate analysis and multivariate analysis.ResultsThe chest X-rays (CXRs) at the admission of 273 patients (mean age 59 years +/-16, 42.1% were male) were scored. In the univariate analysis, age, vaccination status, previous disease, NEWS2, a saturation of peripheral oxygen (Sp02), the Brixia and TSS scores were significant predictors of mortality (p-value < 0.05). In multivariate analysis, there were statistically significant differences in mortality between age, Sp02, Brixia score, and patients with previous diseases were independent predictors of mortality and hospitalization.A gradient boosting machine was performed in the train data set, which showed that the best hyperparameters for predicting the mortality of patients are the Brixia score (exclude TSS score). In the top five predictors, an increase in Brixia, age, and BMI increased the logarithmic number of probability clarifying as death status. Although the TSS and Brixia scores evaluated chest imaging, the TSS score was not essential as the Brixia score (rank 6/11). It was clear that the BMI and NEWS2 score was positively correlated with the Brixia score, and age did not affect this correlation. Meanwhile, we did not find any trend between the TSS score versus BMI and NEWS2.ConclusionWhen integrated with the BMI and NEWS2 clinical classification systems, the severity score of COVID-19 chest radiographs, particularly the Brixia score, was an excellent predictor of all-cause in-hospital mortality.

National early warning score (NEWS) 2 predicts hospital mortality from COVID-19 patients

BackgroundCOVID-19 has a high risk of mortality, especially in patients with comorbid diseases such as cardiac disease, type 2 diabetes mellitus, chronic kidney disease, and hypertension. The National Early Warning Score (NEWS) is a tool that helps in identifying changes in patient conditions that require intensive treatment. ObjectiveAnalyzing NEWS-2 to identify the risk of death in COVID-19 patients. MethodsThis research was conducted from June to July 2020 by using quota sampling. The number of participants in this study was 112 participants (case group = 56 participants and control group = 56 participants). Participants were assessed for NEWS-2 and evaluated for their treatment outcomes. The analysis used in this study was the Chi-squared test and logistic regression with p < 0.05. Results45 participants died of having NEWS-2 score >5, and as many as 50 participants showed an improvement in their condition by having NEWS-2 score 5 (OR = 34.091; p < 0.001). The accuracy of NEWS-2's assessment of mortality of COVID-19 patients had a sensitivity of 80.4% and a specificity of 89.3%. There were several comorbid diseases that had a significant relationship on mortality of COVID-19 patients such as cardiac disease (β = 5.907; 1.107–31.527 95% CI; p = 0.038), T2DM (β = 3.143; 1.269–7.783 95% CI; p = 0.013), CKD (β = 3.851; 1.195–12.416 95% CI; p = 0.024), and hypertension (β = 2.820; 1.075–7.399 95% CI; p = 0.035). ConclusionThe NEWS-2 can be used to identify the risk of death of COVID-19 patients.

Reassessment of disease severity routine laboratory tests in the COVID-19 infection

Introduction. Publications demonstrate some limitations of National Early Warning Score 2 (NEWS-2) accuracy in assessment on coronavirus infection severity.The purpose of this study was to determine the value of the patient’s age and routine laboratory parameters in the assessment of patient’s general condition in coronavirus pneumonia and their relation to NEWS-2 scale parameters.Materials and methods. 50 case reports of patients with COVID-19 infection observed in the Sechenov University in January–March 2021 were analyzed. 34 % of patients were males aged 31 to 89 years (average age 55 years) and 66 % — females aged 40 to 91 (mean age 63). The diagnosis of pneumonia was confirmed by computed tomography. NEWS-2 scale total score was assessed.Results. According to the physician’s subjective assessment the condition was significantly more often assessed as moderate and severe. There was only a weak correlation between the blood oxygen saturation and the total NEWS-2 score (r = 0.165, α = 0.1). We found a mild correlation (r = 0.341, α = 0.1) between the patient’s age and NEWS2 score. Among the most significantly interrelated parameters were age, neutrophil count, serum creatinine, CRP, fibrinogen level. Seven interrelated parameters (age, body temperature, blood oxygen saturation, the neutrophils count, creatinine, CRP, fibrinogen), for which a reliable relation with other tests has been shown, were assigned with its special index according to their contribution to the assessment of the overall condition severity. An aggregated score (criterion X) was proposed for assessment of disease severity according to equation. The proportions of mild, moderate, and severe cases according to criterion X were 12 %, 64 % and 24 %.Conclusion. The preliminary results obtained in the study emphasize the importance of routine laboratory tests in assessment of coronavirus infection severity. An evident discrepancy between NEWS-2 score and X criterion may be very important for practice.

P19 IV antimicrobial duration in practice

BackgroundTackling antimicrobial resistance by reducing unnecessary or inappropriate prescribing is a key priority.ObjectivesTo review current clinical practice at Guy's and St Thomas’ Hospital around duration of IV antimicrobial therapy framed with Start Smart Then Focus national guidelines.MethodsNewly started inpatient prescriptions for IV antimicrobials over three consecutive Mondays were reviewed. Prescriptions not for treatment of acute infections were excluded, as were patients admitted to critical care, obstetrics/gynaecology and paediatric wards. Each patient's record was reviewed at Day 0, 3 and 5. Data were analysed using IBM® SPSS Statistics version 27.ResultsIn total, 80 patients with 89 antibiotic prescriptions (71 = β-lactam, 5 = aminoglycoside, 2 = glycopeptide, 1 = ciprofloxacin, 9 = metronidazole, 1 = linezolid) were included. Median age was 66 (IQR 53–75). Documented indications were for suspected or proven infection of urinary tract (15%), respiratory tract (25%), skin/soft tissue (14%), sepsis (1.25%), intra-abdominal (15%), bacteraemia (7.5%), bone and joint infections (2.5%) or other (20%). Median initial NEWS2 on Day 0 was 3 (IQR 1–4), WCC 11.45 (IQR 8.27–14.15) and CRP 121 (IQR 47–208). Median length of stay was 7.5 days. Median duration of IV antimicrobial was 4 (IQR 2–6) days. By D3, 3 patients had died and 16 had been discharged. Of 61 remaining inpatients on D3, 4 had their antimicrobials switched, 14 had been switched to PO antimicrobials, 43 were continued on IV antibiotics. By D5, 17 further patients had been discharged, 44 remained inpatients. Twenty-two had stopped antimicrobials with 22 continuing IV therapy. A number of patients could have been switched from IV to oral therapy by current guidance but were not (D3 x = 11, D5 n = 8). Higher median D0 CRP was seen in those who continued on IV therapy on D3 (139 versus 79 mg/dL) as was higher D3 WCC (13.9 versus 11.9 × 109/L). There was no significant relationship between a NEWS2 score ≥3 and IV to PO switch at D3 or D5. Thirty-two patients had input from the Infection team within 7 days of first prescription. Fifteen patients (21%) received IV antibiotics for more than 7 days, and 14/15 had Infection team input. Three patients were discharged with OPAT.ConclusionsMedian duration of IV therapy for suspected/proven infections in our centre is less than 5 days and only 28% of patients were still receiving IV antibiotics by D5. A number of missed opportunities for earlier switch to oral therapy were identified. The potential for earlier safe discontinuation of IV therapy using patient-specific measures should be explored. A minority of patients received IV therapy for >7 days, and this was almost universally associated with specialist Infection involvement in complex infections with a view to optimizing patient management and antimicrobial stewardship.

A machine learning model for predicting deterioration of COVID-19 inpatients

The COVID-19 pandemic has been spreading worldwide since December 2019, presenting an urgent threat to global health. Due to the limited understanding of disease progression and of the risk factors for the disease, it is a clinical challenge to predict which hospitalized patients will deteriorate. Moreover, several studies suggested that taking early measures for treating patients at risk of deterioration could prevent or lessen condition worsening and the need for mechanical ventilation. We developed a predictive model for early identification of patients at risk for clinical deterioration by retrospective analysis of electronic health records of COVID-19 inpatients at the two largest medical centers in Israel. Our model employs machine learning methods and uses routine clinical features such as vital signs, lab measurements, demographics, and background disease. Deterioration was defined as a high NEWS2 score adjusted to COVID-19. In the prediction of deterioration within the next 7–30 h, the model achieved an area under the ROC curve of 0.84 and an area under the precision-recall curve of 0.74. In external validation on data from a different hospital, it achieved values of 0.76 and 0.7, respectively.