Reassessment of disease severity routine laboratory tests in the COVID-19 infection

Introduction. Publications demonstrate some limitations of National Early Warning Score 2 (NEWS-2) accuracy in assessment on coronavirus infection severity.

The purpose of this study was to determine the value of the patient’s age and routine laboratory parameters in the assessment of patient’s general condition in coronavirus pneumonia and their relation to NEWS-2 scale parameters.

Materials and methods. 50 case reports of patients with COVID-19 infection observed in the Sechenov University in January–March 2021 were analyzed. 34 % of patients were males aged 31 to 89 years (average age 55 years) and 66 % — females aged 40 to 91 (mean age 63). The diagnosis of pneumonia was confirmed by computed tomography. NEWS-2 scale total score was assessed.

Results. According to the physician’s subjective assessment the condition was significantly more often assessed as moderate and severe. There was only a weak correlation between the blood oxygen saturation and the total NEWS-2 score (r = 0.165, α = 0.1). We found a mild correlation (r = 0.341, α = 0.1) between the patient’s age and NEWS2 score. Among the most significantly interrelated parameters were age, neutrophil count, serum creatinine, CRP, fibrinogen level. Seven interrelated parameters (age, body temperature, blood oxygen saturation, the neutrophils count, creatinine, CRP, fibrinogen), for which a reliable relation with other tests has been shown, were assigned with its special index according to their contribution to the assessment of the overall condition severity. An aggregated score (criterion X) was proposed for assessment of disease severity according to equation. The proportions of mild, moderate, and severe cases according to criterion X were 12 %, 64 % and 24 %.

Conclusion. The preliminary results obtained in the study emphasize the importance of routine laboratory tests in assessment of coronavirus infection severity. An evident discrepancy between NEWS-2 score and X criterion may be very important for practice. 

1. Patient assessment scales. https://www.airhab.org/sc.

2. Belyalov F.I. Use of prognosis scales in clinical medicine. Rossiyskiy kardiologicheskiy zhurnal. 2016;12(140):23–7 (In Russ.). DOI: 10.15829/1560-4071-2016-12-23-27

3. Smith G.B., Redfern O.C., Pimentel M.A., Gerry S., Collins G.S., Malycha J., et al. The National Early Warning Score 2 (NEWS2). Clin Med (Lond). 2019;19(3):260. DOI: 10.7861/clinmedicine.19-3-260

4. Baker K.F., Hanrath A.T., Schim van der Loeff I., Kay L.J., Back J., Duncan C.J. National Early Warning Score 2 (NEWS2) to identify inpatient COVID-19 deterioration: a retrospective analysis. Clin Med (Lond). 2021;21(2):84–9. DOI: 10.7861/clinmed.2020-0688

5. Carr E., Bendayan R., Bean D., Stammers M., Wang W., Zhang H., et al. Evaluation and improvement of the National Early Warning Score (NEWS2) for COVID-19: a multi-hospital study. BMC Med. 2021;19(1):23. DOI: 10.1186/s12916-020-01893-3

6. Lim N.T., Pan D., Barker J. NEWS2 system requires modification to identify deteriorating patients with COVID-19. Clin Med (Lond). 2020;20(4):e133–4. DOI: 10.7861/clinmed.Let.20.4.6

7. Gattinoni L., Chiumello D., Caironi P., Busana M., Romitti F., Brazzi L., Camporota L. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med. 2020;46(6):1099–102. DOI: 10.1007/s00134-020-06033-2

8. Ranjeva S., Pinciroli R., Hodell E., Mueller A., Hardin C.C., Thompson B.T., Berra L. Identifying clinical and biochemical phenotypes in acute respiratory distress syndrome secondary to coronavirus disease-2019. E Clinical Medicine. 2021;34:100829. DOI: 10.1016/j.eclinm.2021.100829

9. Prevention, diagnosis and treatment of new coronavirus infection (COVID-19). Temporary guidelines. Version 11 (07/05/2021) (In Russ.). URL: https://xn-80aesfpebagmfblc0a.xn-p1ai/ai/doc/872/attach/Bmr_COVID-19_compressed.pdf