Evaluation and improvement of the National Early Warning Score (NEWS2) for COVID-19: a multi-hospital study

被引:75
|
作者
Carr, Ewan [1 ]
Bendayan, Rebecca [1 ,2 ,3 ]
Bean, Daniel [1 ,4 ]
Stammers, Matt [5 ,6 ,7 ]
Wang, Wenjuan [8 ]
Zhang, Huayu [9 ]
Searle, Thomas [1 ,2 ,3 ]
Kraljevic, Zeljko [1 ]
Shek, Anthony [10 ]
Phan, Hang T. T. [5 ,6 ]
Muruet, Walter [8 ]
Gupta, Rishi K. [11 ]
Shinton, Anthony J. [7 ]
Wyatt, Mike [12 ]
Shi, Ting [9 ]
Zhang, Xin [13 ]
Pickles, Andrew [1 ,2 ,3 ,13 ]
Stahl, Daniel [1 ]
Zakeri, Rosita [14 ,15 ]
Noursadeghi, Mahdad [16 ]
O'Gallagher, Kevin [14 ,15 ]
Rogers, Matt [12 ]
Folarin, Amos [4 ,14 ,17 ,18 ]
Karwath, Andreas [19 ,20 ]
Wickstrom, Kristin E. [21 ]
Kohn-Luque, Alvaro [22 ]
Slater, Luke [19 ,20 ]
Cardoso, Victor Roth [19 ,20 ]
Bourdeaux, Christopher [12 ]
Holten, Aleksander Rygh [23 ,24 ]
Ball, Simon [25 ]
McWilliams, Chris [26 ]
Roguski, Lukasz [4 ,17 ,20 ]
Borca, Florina [5 ,6 ,7 ]
Batchelor, James [5 ]
Amundsen, Erik Koldberg [21 ]
Wu, Xiaodong [27 ,28 ]
Gkoutos, Georgios, V [19 ,20 ,25 ]
Sun, Jiaxing [27 ]
Pinto, Ashwin [7 ]
Guthrie, Bruce [9 ]
Breen, Cormac [8 ]
Douiri, Abdel [8 ]
Wu, Honghan [4 ,17 ]
Curcin, Vasa [8 ]
Teo, James T. [10 ,14 ]
Shah, Ajay M. [14 ,15 ]
Dobson, Richard J. B. [1 ,2 ,3 ,4 ,17 ,18 ]
机构
[1] Kings Coll London, Inst Psychiat Psychol & Neurosci IoPPN, Dept Biostat & Hlth Informat, 16 Crespigny Pk, London SE5 8AF, England
[2] South London & Maudsley NHS Fdn Trust, NIHR Biomed Res Ctr, London, England
[3] Kings Coll London, London, England
[4] UCL, Hlth Data Res UK London, London, England
[5] Univ Southampton, Clin Informat Res Unit, Coxford Rd, Southampton SO16 5AF, Hants, England
[6] Univ Hosp Southampton NHS Trust, NIHR Biomed Res Ctr, Coxford Rd, Southampton, Hants, England
[7] Univ Hosp Southampton, UHS Digital, Tremona Rd, Southampton SO16 6YD, Hants, England
[8] Kings Coll London, Sch Populat Hlth & Environm Sci, London, England
[9] Univ Edinburgh, Usher Inst, Edinburgh, Midlothian, Scotland
[10] Kings Coll London, Inst Psychiat Psychol & Neurosci, Dept Clin Neurosci, London, England
[11] Univ Coll London Hosp NHS Trust, UCL Inst Global Hlth, London, England
[12] Univ Hosp Bristol & Weston NHS Fdn Trust, Bristol, Avon, England
[13] Peoples Liberat Army Joint Logist Support Force 9, Dept Pulm & Crit Care Med, Kunming, Yunnan, Peoples R China
[14] Kings Coll Hosp NHS Fdn Trust, London, England
[15] Kings Coll London, British Heart Fdn Ctr Excellence, Sch Cardiovasc Med & Sci, London SE5 9NU, England
[16] Univ Coll London Hosp NHS Trust, UCL Div Infect & Immun, London, England
[17] UCL, Inst Hlth Informat, London, England
[18] Univ Coll London Hosp NHS Fdn Trust, NIHR Biomed Res Ctr, London, England
[19] Univ Birmingham, Inst Canc & Genom, Coll Med & Dent Sci, Birmingham, W Midlands, England
[20] Univ Hosp Birmingham NHS Fdn Trust, Inst Translat Med, Birmingham, W Midlands, England
[21] Oslo Univ Hosp, Blood Cell Res Grp, Dept Med Biochem, Oslo, Norway
[22] Univ Oslo, Oslo Ctr Biostat & Epidemiol, Fac Med, Oslo, Norway
[23] Oslo Univ Hosp, Dept Acute Med, Oslo, Norway
[24] Univ Oslo, Inst Clin Med, Oslo, Norway
[25] Univ Hosp Birmingham NHS Fdn Trust, Birmingham, W Midlands, England
[26] Univ Bristol, Dept Engn Math, Bristol, Avon, England
[27] Tongji Univ, Shanghai East Hosp, Dept Pulm & Crit Care Med, Shanghai, Peoples R China
[28] Taikang Tongji Hosp, Dept Pulm & Crit Care Med, Wuhan, Peoples R China
基金
英国医学研究理事会; 英国工程与自然科学研究理事会; 英国科研创新办公室; 英国经济与社会研究理事会; 中国国家自然科学基金; 欧盟地平线“2020”; 英国惠康基金; 美国国家卫生研究院;
关键词
NEWS2; score; Blood parameters; COVID-19; Prediction model; RISK;
D O I
10.1186/s12916-020-01893-3
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background The National Early Warning Score (NEWS2) is currently recommended in the UK for the risk stratification of COVID-19 patients, but little is known about its ability to detect severe cases. We aimed to evaluate NEWS2 for the prediction of severe COVID-19 outcome and identify and validate a set of blood and physiological parameters routinely collected at hospital admission to improve upon the use of NEWS2 alone for medium-term risk stratification. Methods Training cohorts comprised 1276 patients admitted to King's College Hospital National Health Service (NHS) Foundation Trust with COVID-19 disease from 1 March to 30 April 2020. External validation cohorts included 6237 patients from five UK NHS Trusts (Guy's and St Thomas' Hospitals, University Hospitals Southampton, University Hospitals Bristol and Weston NHS Foundation Trust, University College London Hospitals, University Hospitals Birmingham), one hospital in Norway (Oslo University Hospital), and two hospitals in Wuhan, China (Wuhan Sixth Hospital and Taikang Tongji Hospital). The outcome was severe COVID-19 disease (transfer to intensive care unit (ICU) or death) at 14 days after hospital admission. Age, physiological measures, blood biomarkers, sex, ethnicity, and comorbidities (hypertension, diabetes, cardiovascular, respiratory and kidney diseases) measured at hospital admission were considered in the models. Results A baseline model of 'NEWS2 + age' had poor-to-moderate discrimination for severe COVID-19 infection at 14 days (area under receiver operating characteristic curve (AUC) in training cohort = 0.700, 95% confidence interval (CI) 0.680, 0.722; Brier score = 0.192, 95% CI 0.186, 0.197). A supplemented model adding eight routinely collected blood and physiological parameters (supplemental oxygen flow rate, urea, age, oxygen saturation, C-reactive protein, estimated glomerular filtration rate, neutrophil count, neutrophil/lymphocyte ratio) improved discrimination (AUC = 0.735; 95% CI 0.715, 0.757), and these improvements were replicated across seven UK and non-UK sites. However, there was evidence of miscalibration with the model tending to underestimate risks in most sites. Conclusions NEWS2 score had poor-to-moderate discrimination for medium-term COVID-19 outcome which raises questions about its use as a screening tool at hospital admission. Risk stratification was improved by including readily available blood and physiological parameters measured at hospital admission, but there was evidence of miscalibration in external sites. This highlights the need for a better understanding of the use of early warning scores for COVID.
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页数:16
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