National Early Warning Score accurately discriminates the risk of serious adverse events in patients with liver disease

Theresa J. Hydes, Paul Meredith, Paul E. Schmidt, Gary B. Smith, David R. Prytherch, Richard J. Aspinall*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Background & Aims - The National Early Warning Score (NEWS) is used to identify deteriorating adult hospital inpatients. However, it includes physiological parameters frequently altered in patients with cirrhosis. We aimed to assess the performance of the NEWS in acute and chronic liver diseases. 

Methods - We collected vital signs, recorded in real time, from completed consecutive admissions of patients 16 years or older to a large acute-care hospital in Southern England, from January 1, 2010, through October 31, 2014. Using International Classification of Diseases, 10th revision, codes, we categorized patients as having primary liver disease, secondary liver disease, or none. For patients with liver disease, 2 analysis groups were developed: the first was based on clinical group (such as acute or chronic, alcohol-induced, or associated with portal hypertension), and the second was based on a summary of liver-related, hospital-level mortality indicator diagnoses. For each, we compared the abilities of the NEWS and 34 other early warning scores to discriminate 24-hour mortality, cardiac arrest, or unanticipated admission to the intensive care unit using the area under the receiver operating characteristic (AUROC) curve and early warning score efficiency curve analyses. 

Results - The NEWS identified patients with primary, nonprimary, and no diagnoses of liver disease with AUROC values of 0.873 (95% CI, 0.860–0.886), 0.898 (95% CI, 0.891–0.905), and 0.879 (95% CI, 0.877–0.881), respectively. High AUROC values were also obtained for all clinical subgroups; the NEWS identified patients with alcohol-related liver disease with an AUROC value of 0.927 (95% CI, 0.912–0.941). The NEWS identified patients with liver diseases with higher AUROC values than other early warning scoring systems. 

Conclusions - The NEWS accurately discriminates patients at risk of death, admission to the intensive care unit, or cardiac arrest within a 24-hour period for a range of liver-related diagnoses. Its widespread use provides a ready-made, easy-to-use option for identifying patients with liver disease who require early assessment and intervention, without the need to modify parameters, weightings, or escalation criteria.

Original languageEnglish
Pages (from-to)1657-1666
JournalClinical Gastroenterology and Hepatology
Issue number10
Early online date24 Dec 2017
Publication statusPublished - Oct 2018


  • Alcohol
  • Cirrhosis
  • Liver Failure
  • Portal Hypertension
  • Sepsis


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