Correlation of national early warning score 2 with outcomes of acute exacerbation of chronic obstructive pulmonary disease.

Abstract

Objective: To evaluate the correlation of the National Early Warning Score 2 (NEWS2) at admission with the clinical outcomes in patients presenting with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Study Design: Prospective Longitudinal Observational study. Setting: Department of Medicine, Shifa International Hospital, Islamabad. Period: Sep-2025 to Feb-2026. Methods: A total of 207 patients aged ≥18 years with a confirmed diagnosis of chronic obstructive pulmonary disease and presenting with acute exacerbation requiring hospital admission, were enrolled. The NEWS2 was calculated at the time of presentation and patients were categorized into low (0–4), medium (5–6), and high (≥7) risk categories accordingly. In-hospital mortality was recorded during the hospital stay, while 3-month mortality and recurrence of exacerbation were assessed using hospital records and/or telephonic follow-up. Spearman correlation was used for statistical analysis considering p<0.05 as significant. Results: When assessed using the NEWS2, the majority of patients fell in the high-risk category (52.66%) followed by medium-risk (30%) and low risk (17.39%). A statistically significant but weak correlation was observed between NEWS2 risk category and in-hospital mortality (r = 0.183, p = 0.008), which indicates that higher NEWS2 risk category was associated with increased in-hospital mortality. A clinically meaningful progressive gradient across risk categories was also shown for 3-month mortality and exacerbation frequency; however, these did not reach statistical significance. Conclusion: NEWS2 demonstrates directional utility as an early bedside risk stratification tool in patients presenting with AECOPD, supporting its integration into the routine decision-making at emergency departments.