Evaluating the national early warning score (NEWS) and NEWS-calcium for predicting adverse outcomes in acute pancreatitis: a prospective cohort study in Vietnam

Abstract

Background and aim: Identifying acute pancreatitis (AP) patients at risk of severe progression remains a challenge. The National Early Warning Score (NEWS) has been shown to effectively predict adverse outcomes (intensive care unit (ICU) admission and mortality) in critically ill patients, including AP. The combined model of NEWS and serum calcium (NEWS-Calcium) is hypothesized to enhance predictive accuracy. This study evaluates the value of NEWS and NEWS-Calcium in predicting adverse outcomes in AP, and compares them with the Bedside Index for Severity in Acute Pancreatitis (BISAP). Materials and methods: A prospective cohort study was conducted with AP patients at a tertiary hospital in Vietnam. Patient data, including general characteristics, nonseveresigns and symptoms, laboratory, and radiology results, was collected. Various scores were assessed on the day of admission. The optimal cut-off points and the area under the curve (AUC) were determined using ROC curve analysis. Results: Among 220 patients, 137 (62.3%) were male, mean age was 47.3 ± 16.1 years. The proportions of non-severe and severe disease were 75.0% and 25.0%. 54 patients (24.5%) were admitted to the ICU and 16 (7.3%) died. The AUC values for NEWS, NEWS-Calcium, and BISAP for predicting ICU admission were 0.893, 0.903, and 0.862, respectively, and for predicting mortality were 0.846, 0.869, and 0.863, respectively. There was no statistically significant difference in AUC among the three scoring systems for predicting ICU admission (p = 0.441) and mortality (p = 0.645). In predicting ICU admission, the NEWS (≥4) and NEWS-Calcium (≥4) showed sensitivities of 79.6% and 91.0%, and specificities of 88.9% and 84.3%, respectively. For predicting mortality, the NEWS (≥6) and NEWS-Calcium (≥6) had sensitivities of 75.0% and 87.3%, and specificities of 81.3% and 80.4%, respectively. Conclusion: Both NEWS and NEWS-Calcium demonstrated good predictive value for adverse outcomes in acute pancreatitis, with AUCs ranging from 0.846 to 0.903, comparable to the BISAP score.