Ryan C Maves1,2,3, Stephanie A Richard1,4, David A Lindholm5,6, Nusrat Epsi1,4, Derek T Larson7, Christian Conlon8, Kyle Everson8, Steffen Lis8, Paul W Blair9,10, Sharon Chi1,4,11, Anuradha Ganesan1,4,12, Simon Pollett1,4, Timothy H Burgess1, Brian K Agan1,4, Rhonda E Colombo1,4,8, Christopher J Colombo6,8. 1. Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. 2. Naval Medical Center San Diego, San Diego, California, USA. 3. Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. 4. Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, Maryland, USA. 5. Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, Texas, USA. 6. Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. 7. Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA. 8. Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, USA. 9. Austere Environments Consortium for Enhanced Sepsis Outcomes, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA. 10. Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. 11. Tripler Army Medical Center, Honolulu, Hawaii, USA. 12. Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
Abstract
BACKGROUND: Early recognition of high-risk patients with coronavirus disease 2019 (COVID-19) may improve outcomes. Although many predictive scoring systems exist, their complexity may limit utility in COVID-19. We assessed the prognostic performance of the National Early Warning Score (NEWS) and an age-based modification (NEWS+age) among hospitalized COVID-19 patients enrolled in a prospective, multicenter US Military Health System (MHS) observational cohort study. METHODS: Hospitalized adults with confirmed COVID-19 not requiring invasive mechanical ventilation at admission and with a baseline NEWS were included. We analyzed each scoring system's ability to predict key clinical outcomes, including progression to invasive ventilation or death, stratified by baseline severity (low [0-3], medium [4-6], and high [≥7]). RESULTS: Among 184 included participants, those with low baseline NEWS had significantly shorter hospitalizations (P < .01) and lower maximum illness severity (P < .001). Most (80.2%) of low NEWS vs 15.8% of high NEWS participants required no or at most low-flow oxygen supplementation. Low NEWS (≤3) had a negative predictive value of 97.2% for progression to invasive ventilation or death; a high NEWS (≥7) had high specificity (93.1%) but low positive predictive value (42.1%) for such progression. NEWS+age performed similarly to NEWS at predicting invasive ventilation or death (NEWS+age: area under the receiver operating characteristics curve [AUROC], 0.69; 95% CI, 0.65-0.73; NEWS: AUROC, 0.70; 95% CI, 0.66-0.75). CONCLUSIONS: NEWS and NEWS+age showed similar test characteristics in an MHS COVID-19 cohort. Notably, low baseline scores had an excellent negative predictive value. Given their easy applicability, these scoring systems may be useful in resource-limited settings to identify COVID-19 patients who are unlikely to progress to critical illness. Published by Oxford University Press on behalf of Infectious Diseases Society of America 2021.
BACKGROUND: Early recognition of high-risk patients with coronavirus disease 2019 (COVID-19) may improve outcomes. Although many predictive scoring systems exist, their complexity may limit utility in COVID-19. We assessed the prognostic performance of the National Early Warning Score (NEWS) and an age-based modification (NEWS+age) among hospitalized COVID-19 patients enrolled in a prospective, multicenter US Military Health System (MHS) observational cohort study. METHODS: Hospitalized adults with confirmed COVID-19 not requiring invasive mechanical ventilation at admission and with a baseline NEWS were included. We analyzed each scoring system's ability to predict key clinical outcomes, including progression to invasive ventilation or death, stratified by baseline severity (low [0-3], medium [4-6], and high [≥7]). RESULTS: Among 184 included participants, those with low baseline NEWS had significantly shorter hospitalizations (P < .01) and lower maximum illness severity (P < .001). Most (80.2%) of low NEWS vs 15.8% of high NEWS participants required no or at most low-flow oxygen supplementation. Low NEWS (≤3) had a negative predictive value of 97.2% for progression to invasive ventilation or death; a high NEWS (≥7) had high specificity (93.1%) but low positive predictive value (42.1%) for such progression. NEWS+age performed similarly to NEWS at predicting invasive ventilation or death (NEWS+age: area under the receiver operating characteristics curve [AUROC], 0.69; 95% CI, 0.65-0.73; NEWS: AUROC, 0.70; 95% CI, 0.66-0.75). CONCLUSIONS: NEWS and NEWS+age showed similar test characteristics in an MHS COVID-19 cohort. Notably, low baseline scores had an excellent negative predictive value. Given their easy applicability, these scoring systems may be useful in resource-limited settings to identify COVID-19 patients who are unlikely to progress to critical illness. Published by Oxford University Press on behalf of Infectious Diseases Society of America 2021.
Entities:
Keywords:
COVID-19; early warning score; prognosis
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