One-on-one comparison between qCSI and NEWS scores for mortality risk assessment in patients with COVID-19

Abstract

Objective: To compare the predictive value of the quick COVID-19 Severity Index (qCSI) and theNational Early Warning Score (NEWS) for 90-day mortality amongst COVID-19 patients.Methods: Multicenter retrospective cohort study conducted in adult patients transferred by ambulance to an emergency department (ED) with suspected COVID-19 infection subsequently confirmed by a SARS-CoV-2 test (polymerase chain reaction). We collected epidemiological data,clinical covariates (respiratory rate, oxygen saturation, systolic blood pressure, heart rate, temperature, level of consciousness and use of supplemental oxygen) and hospital variables. The primary outcome was cumulative all-cause mortality during a 90-day follow-up, with mortality assessment monitoring time points at 1, 2, 7, 14, 30 and 90 days from ED attendance. Comparison of performances for 90-day mortality between both scores was carried out by univariate analysis.Results: From March to November 2020, we included 2,961 SARS-CoV-2 positive patients(median age 79 years, IQR 66–88), with 49.2% females. The qCSI score provided an AUC rangingfrom 0.769 (1-day mortality) to 0.749 (90-day mortality), whereas AUCs for NEWS ranging from0.825 for 1-day mortality to 0.777 for 90-day mortality. At all-time points studied, differencesbetween both scores were statistically significant (p<.001).Conclusion: Patients with SARS-CoV-2 can rapidly develop bilateral pneumonias with multiorgandisease; in these cases, in which an evacuation by the EMS is required, reliable scores for anearly identification of patients with risk of clinical deterioration are critical. The NEWS score provides not only better prognostic results than those offered by qCSI at all the analyzed timepoints, but it is also better suited for COVID-19 patients.