Predictive Value of an Age-Based Modification of the National Early Warning System in Hospitalized Patients With COVID-19

Abstract

Background Early recognition of high-risk patients with 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 U.S. Military Health System (MHS) observational cohort study. Methods Hospitalized adults with confirmed COVID-19 not requiring invasive mechanical ventilation at admission and 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<0.01) and lower maximum illness severity (p<0.001). Most (80.2%) of low NEWS versus 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: AUROC 0.69; 95% CI 0.65-0.73; NEWS: AUROC 0.70; 0.66-0.75). Conclusions NEWS and NEWS+age showed similar test characteristics in an MHS COVID-19 cohort. Notably, low baseline scores had 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.

Using ISARIC 4C mortality score to predict dynamic changes in mortality risk in COVID-19 patients during hospital admission

“…However, NEWS2 doesn’t include any biochemical measurements, nor age or sex, which are known to be significant contributors to COVID-19 mortality [ 13 ]. Other studies have added age to NEWS parameters to improve accuracy, but these are lower than the dynamic application of ISARIC 4C described here [ 14 ].…”

Predicting critical illness on initial diagnosis of COVID-19 based on easily-obtained clinical variables: author's response

“…Of note, Knight et al [4] compared in a large external validation cohort the 4C Mortality Score against NEWS, reporting a C-statistic of 0.774 for 4C Mortality Score vs. 0.654 for NEWS, in predicting inhospital mortality. Additionally, Maves et al [5] showed that the simple addition of age to NEWS appeared to improve the score's ability to predict progression to invasive ventilation or death among hospitalized COVID-19 patients. In summary, we agree that the comparison of PRIORITY and NEWS2 could be interesting due to their similarities, the prognostic value of predictors not included in NEWS2, such as age or previous comorbidities, should be considered.…”