Prower Emma, Grant David, Bisquera Alessandra, Breen Cormac P, Camporota Luigi, Gavrilovski Maja, Pontin Megan, Douiri Abdel, Glover Guy W
Department of Critical Care, Kings College Hospital, Denmark Hill, London SE5 9RS, UK.
Department of clinical informatics for health informatics, Guys and St Thomas NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK.
EClinicalMedicine. 2021 May;35:100828. doi: 10.1016/j.eclinm.2021.100828. Epub 2021 Apr 25.
Patients admitted to hospital with Covid-19 are at risk of deterioration. The National Early Warning Score (NEWS2) is widely recommended, however it's validity in Covid-19 is not established and indices more specific for respiratory failure may be more appropriate. We aim to describe the physiological antecedents to deterioration, test the predictive validity of NEWS2 and compare this to the ROX index ([SpO/FiO]/respiratory rate).
A single centre retrospective cohort study of adult patients who were admitted to a medical ward, between 1/3/20 and 30/5/20, with positive results for SARS-CoV-2 RNA. Physiological observations and the NEWS2 were extracted and analysed. The primary outcome was a composite of cardiac arrest, unplanned critical care admission or death within 24 hours. A generalized linear model was used to assess the association of physiological values, NEWS2 and ROX with the outcome.
The primary outcome occurred in 186 patients (26%). In the preceding 24 hours, deterioration was most marked in respiratory parameters, specifically in escalating oxygen requirement; tachypnoea was a late sign, whilst cardiovascular observations remained stable. The area under the receiver operating curve was 0.815 (95% CI 0.804-0.826) for NEWS2 and 0.848 (95% CI 0.837-0.858) for ROX. Applying the optimal level of ROX, the majority of patients triggered four hours earlier than with NEWS2 of 5.
NEWS2 may under-perform in Covid-19 due to intrinsic limitations of the design and the unique pathophysiology of the disease. A simple index utilising respiratory parameters can outperform NEWS2 in predicting the occurrence of adverse events.
因新冠病毒病（Covid-19）入院的患者有病情恶化的风险。国家早期预警评分（NEWS2）被广泛推荐，然而其在Covid-19中的有效性尚未确立，而对呼吸衰竭更具特异性的指标可能更为合适。我们旨在描述病情恶化的生理先兆，测试NEWS2的预测有效性，并将其与ROX指数（[血氧饱和度/吸入氧浓度]/呼吸频率）进行比较。
一项单中心回顾性队列研究，研究对象为2020年3月1日至5月30日期间入住内科病房、严重急性呼吸综合征冠状病毒2（SARS-CoV-2）RNA检测呈阳性的成年患者。提取并分析生理观察指标和NEWS2。主要结局为24小时内的心搏骤停、非计划重症监护病房入院或死亡的复合结局。采用广义线性模型评估生理值、NEWS2和ROX与结局之间的关联。
186例患者（26%）出现主要结局。在之前的24小时内，呼吸参数的恶化最为明显，尤其是吸氧需求不断增加；呼吸急促是晚期表现，而心血管观察指标保持稳定。NEWS2的受试者工作特征曲线下面积为0.815（95%置信区间0.804-0.826），ROX为0.848（95%置信区间0.837-0.858）。应用ROX的最佳水平，大多数患者比NEWS2提前4小时触发警报，而NEWS2的触发警报时间为5小时。
由于设计的内在局限性和该疾病独特的病理生理学，NEWS2在Covid-19中可能表现不佳。一个利用呼吸参数的简单指标在预测不良事件的发生方面可能优于NEWS2。
