Performance of NEWS, qSOFA, and SIRS Scores for Assessing Mortality, Early Bacterial Infection, and Admission to ICU in COVID-19 Patients in the Emergency Department

Julio Alencar; Luz Marina Gómez Gómez; Andre Lazzeri Cortez; Heraldo Possolo de Souza; Anna Sara Levin; Matias Chiarastelli Salomão

doi:10.3389/fmed.2022.779516

Performance of NEWS, qSOFA, and SIRS Scores for Assessing Mortality, Early Bacterial Infection, and Admission to ICU in COVID-19 Patients in the Emergency Department

Front Med (Lausanne). 2022 Mar 2:9:779516. doi: 10.3389/fmed.2022.779516. eCollection 2022.

Authors

Julio Alencar¹, Luz Marina Gómez Gómez¹, Andre Lazzeri Cortez², Heraldo Possolo de Souza^{1

3}, Anna Sara Levin^{2

4}, Matias Chiarastelli Salomão²

Affiliations

¹ Departamento de Emergência Médica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
² Departamento de Moléstias Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
³ Departamento de Emergência Médica, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
⁴ Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.

Abstract

SARS-CoV-2 infection has a wide spectrum of presentations, from asymptomatic to pneumonia and sepsis. Risk scores have been used as triggers for protocols that combine several interventions for early management of sepsis. This study tested the accuracy of the score SIRS, qSOFA, and NEWS in predicting outcomes, including mortality and bacterial infection, in patients admitted to the emergency department (ED) during the COVID-19 pandemic. We described 2,473 cases of COVID-19 admitted to the ED of the largest referral hospital for severe COVID-19 in Brazil during the pandemic. SIRS, qSOFA and NEWS scores showed a poor performance as prognostic scores. However, NEWS score had a high sensitivity to predict in-hospital death (0.851), early bacterial infection (0.851), and ICU admission (0.868), suggesting that it may be a good screening tool for severe cases of COVID-19, despite its low specificity.

Keywords: COVID-19; NEWS; SIRS (for Systemic Inflammatory Response Syndrome); emergency; prognosis; qSOFA (quick sequential organ failure assessment); scores; sepsis.