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The National Early Warning Score (NEWS) Predicts the 28-Day Mortality in Patients With Severe Fever With
Tianshu Mei1, Ying Xia1, Ping Huang1
1Department of Emergency Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
Objective:
To investigate the association between the New Early Warning Score (NEWS) and 28-day mortality in patients with severe fever with thrombocytopenia syndrome (SFTS).
Design:
A cross-sectional derivation and validation study.
Methods:
A total of 382 SFTS patients were included in retrospective and prospective studies. The primary outcome was short-term (28-day) mortality. Cox regression, receiver operating characteristic (ROC), and Kaplan-Meier analysis were utilised in the retrospective study to assess the association between NEWS and mortality. The prospective study assessed the applicability of the NEWS.
Reporting Method:
This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
Results:
Among 219 SFTS patients in the retrospective study, 27 (12.3%) died within 28 days. NEWS was significantly higher in non-survivors than in survivors (4.00 [1.00, 5.00] vs. 1.00 [1.00, 2.00]). The ROC curve for MEWS predicting 28-day mortality showed an area under the curve (AUC) of 0.757 (95% confidence interval: 0.65-0.87), with a cut-off of 3.5 (sensitivity: 90.6%; specificity: 55.6%). SFTS patients were stratified into low (NEWS < 4), medium (NEWS 4-6), and high (NEWS > 6) risk groups. Kaplan-Meier analysis showed significantly lower survival rates in medium and high risk groups compared to the low risk group. The prospective study included 63 SFTS patients, of whom 11 (17.5%) died. 28-day mortality significantly increased across NEWS categories: [low risk (4/50, 8.0%), medium risk (4/8, 50.0%), high risk (3/5, 60.0%)].
Conclusions:
NEWS was a quicker, simpler, and valuable parameter to identify SFTS patients at risk of 28-day mortality.
Relevance To Clinical Practice:
An elevated NEWS at admission is associated with a higher risk of poor short-term prognosis in SFTS patients. Incorporating NEWS into emergency nursing practice may aid in the early identification of SFTS patients at risk of adverse prognosis.
Patient Or Public Contribution:
Emergency nurses performed the NEWS for the SFTS patients at admission.
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