Early identification of high-risk septic patients requiring critical care: Diagnostic accuracy of NEWS and qSOFA using hierarchical modeling

Abstract

Introduction: Early identification of septic patients at risk of deterioration is essential for care escalation and outcomes. This study evaluated the accuracy and utility of the National Early Warning Score (NEWS) and quick Sequential Organ Failure Assessment (qSOFA) for predicting mortality and identifying sepsis patients who may require critical care. Methods: PubMed, Cochrane Library, and Google Scholar were searched for studies evaluating NEWS and qSOFA in adults with suspected infection or sepsis. Data were extracted to construct 2 × 2 tables. A bivariate random-effects model estimated sensitivity and specificity, and hierarchical summary receiver operating characteristic curves, diagnostic odds ratios (DORs), and post-test probabilities assessed utility. Results: Ten studies involving 17,762 patients met eligibility criteria; five provided 2 × 2 data for in-hospital mortality synthesis. NEWS and qSOFA were associated with mortality (NEWS: risk ratio [RR] = 2.89, 95% confidence interval [CI]: 1.82–4.59; qSOFA: RR = 2.98, 95% CI: 1.84–4.83). NEWS had higher sensitivity (0.71) but lower specificity (0.56); qSOFA had lower sensitivity (0.44) and higher specificity (0.83). Pooled DORs were comparable (NEWS: 3.83; qSOFA: 3.82), indicating similar performance. At a pre-test probability of 15%, positive NEWS and qSOFA increased mortality to 22% and 31%, while negative results reduced it to 8% and 11%, showing complementary risk profiles. Conclusion: NEWS and qSOFA show comparable prognostic performance but distinct diagnostic characteristics. NEWS may enable earlier detection of deterioration risk, whereas qSOFA may better identify higher-risk adverse outcomes. A complementary sequential approach may support early stratification, timely intensive care escalation, and sepsis management decisions.