Validation of NEWS2, SIRS, and qSOFA in Postoperative Cardiac Patients: A Retrospective Cohort Study

Introduction: The 'quick Sepsis Related Organ Failure Assessment' (qSOFA), 'Systemic In-flammatory Response Syndrome' (SIRS), and 'National Early Warning Score' 2 (NEWS2) scores are yet to be comparatively validated in ward-based cardiac surgical patients despite widespread routine use in clinical practice. We sought to assess the predictive validity of NEWS, SIRS, and qSOFA in identifying postoperative, ward-level cardiac surgical patients at risk of poor short-term mortality. Methods: All adult patients who underwent cardiac surgery at a single tertiary center be-tween November 2014 and October 2017 were identified. Data for bedside observations, hematological results, and microbiology requests were obtained from electronic health records. Survival data were acquired from a national registry. The primary outcome was the discriminatory ability, measured by the area under the receiver operating characteristic (AUROC), of each score for in-hospital mortality. Results: One thousand five hundred forty three (male n = 1101, 71%) patients were included. Overall in-hospital mortality was 2.4%. There was no significant difference in discrimina-tory ability of NEWS (AUROC 0.5060), SIRS (AUROC 0.4874), and qSOFA (AUROC 0.5139) for in-hospital mortality (P = 0.881). Sensitivity for this outcome was ubiquitously low (13.51-40.54%). Conclusions: Current illness-severity scores show a low discriminatory ability for in-hospital mortality in ward-based cardiac surgical patients. Caution should be used in the applica-tion of these prognostic screening tools for early detection of poor outcomes in this population. (c) 2023 Elsevier Inc. All reserved.

Automated summary

In ward-based cardiac surgical patients, the NEWS, SIRS, and qSOFA scores demonstrate low discriminatory ability in predicting in-hospital mortality, with universally low sensitivity for this outcome.