NEWS-2 Accuracy in Predicting Mortality and Severe Morbidity Among Hospitalized COVID-19 Patients: A Prospective Cohort Study

<b>Background</b>: Early risk stratification tools for COVID-19 patients have been indicated yet there are few data about their ability to effectively detect clinical deterioration among COVID-19 patients. <b>Objectives</b>: To evaluate the NEWS-2 to predict severe morbidity and mortality for COVID-19 patients admitted to hospitals. <b>Methods</b>: We conducted a prospective cohort study among adult COVID-19 patients with a confirmed diagnosis who were admitted to the inpatient units at COVID-19 Martyrs Medical Military Complex Hospital, from 1 March 2022, until 29 February 2023. NEWS-2 scores were measured at admission and 6, 12, 24, and 48 h after their admission to the hospital using receiver operating characteristic (ROC) curves. <b>Results</b>: Overall, 192 adult COVID-19 patients aged 25-94 years (mean = 62.1, SD = 13.9) were enrolled. Of those, 49.0% were males, 47.4% were vaccinated, and 53.6% had diabetes. The 192 enrolled patients were classified into NEWS-2 score categories, with almost 13% (12.5%) falling into the high-risk category already upon admission. The mean NEWS-2 scores were excellent predictors of mechanical ventilation, admission to the ICU, and mortality, as indicated by an AUROC of 0.94 (95% CI: 0.88-1.00, <i>p</i> < 0.001), 0.91 (95% CI: 0.87-0.96, <i>p</i> < 0.001), and 0.96 (95% CI: 0.92-1.00, <i>p</i> < 0.001), respectively. Significant differences in mean NEWS-2 scores were found between the participating patients, both with and without comorbidity in the course of the patient's stay in the ICU, and mortality (<i>p</i> = 0.004, <i>p</i> = 0.043, respectively). Positive correlations of the high NEWS-2 scores were revealed using a multiple linear regression model, indicating the necessity of administering non-invasive ventilatory assistance (<i>p</i> = 0.013), hospitalization for a minimum of six days (<i>p</i> = 0.013), and admission to the ICU (<i>p</i> = 0.006). Nonetheless, there was a negative association between mortality and the NEWS-2 score (<i>p</i> < 0.001). <b>Conclusions</b>: The NEWS-2 had moderate sensitivity and specificity in predicting the deterioration of patients with COVID-19 whereas there was high sensitivity and specificity in predicting the mortality for patients with COVID-19, both with and without comorbidity. Our findings support the utility of NEWS-2 monitoring as a sensitive approach for initially assessing COVID-19 patients. It could be helpful to enhance the accuracy of predictive performance by supplementing the score parameters by adding biological parameters in addition to clinical judgment.