Comparison of National Early Warning Score 2 (NEWS2) and Quick Sequential Organ Failure Assessment (qSOFA) for...

Sepsis is a major cause of morbidity and mortality worldwide, requiring early recognition and risk stratification to improve outcomes. Clinical scoring systems such as the quick Sequential Organ Failure Assessment (qSOFA) and National Early Warning Score 2 (NEWS2) are commonly used for bedside assessment. While qSOFA was initially proposed as a rapid screening tool, it is no longer favored for sepsis screening due to its limited sensitivity and is now primarily used for prognostication. In contrast, NEWS2 is widely used for early detection of clinical deterioration and risk stratification. This study aimed to compare the predictive performance of qSOFA and NEWS2 for in-hospital mortality in patients admitted with sepsis in a tertiary care center.

This 18-month prospective observational study was conducted at Pushpagiri Medical College Hospital, Thiruvalla, Kerala, India. Consecutive sampling was used to include adult patients with sepsis admitted to the medical intensive care unit (ICU). A total of 155 eligible patients were enrolled. Baseline demographic data, clinical characteristics, comorbidities, and laboratory parameters were recorded at admission. Patients were stratified into high- and low-risk groups based on qSOFA and NEWS2 scores and followed during their hospital stay. In-hospital mortality was the primary outcome, while prolonged ICU stay, need for mechanical ventilation, and requirement for vasopressor or inotropic support were secondary outcomes. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY, USA). The chi-square test was used to assess associations, and receiver operating characteristic (ROC) curves were constructed to evaluate predictive performance.

Among the 155 patients, the mean age was 65.6 ± 14.6 years; 82 (53%) were men, and 73 (47%) were women. Within seven days of admission, 29 patients died. Vasopressor support was required in 119 patients, and 66 patients required mechanical ventilation. NEWS2 demonstrated superior predictive performance compared with qSOFA, with higher specificity, negative predictive value, and area under the ROC curve (AUC) across all outcomes. NEWS2 performed better in predicting in-hospital mortality (AUC 0.949), vasopressor requirement (AUC 0.911), need for mechanical ventilation (AUC 0.883), and prolonged ICU stay (AUC 0.707).

This study demonstrated that NEWS2 is superior to qSOFA for predicting clinically relevant outcomes in patients with sepsis, including in-hospital mortality, prolonged ICU stay, mechanical ventilation, and vasopressor support. Its use may facilitate earlier risk stratification and timely clinical intervention. However, as a single-center study, the generalizability of the findings is limited, and further multicenter studies are warranted.