https://doi.org/10.4081/ecj.2026.15526
Combination of National Early Warning Score 2 and procalcitonin: accuracy for early sepsis recognition in patients admitted from the emergency department for infection
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Accepted: 23 July 2026
Published: 8 October 2026
Prompt recognition of sepsis in the Emergency Department (ED) is challenging. In this study, we performed a prospective study to explore, for the first time, the diagnostic ac-curacy for sepsis of the combination of National Early Warning Score 2 (NEWS2) and Procalcitonin (PCT) in ED population admitted for infection. The endpoint was Sepsis-3-defined sepsis. NEWS2 was calculated at triage using dedicated software, while PCT was measured within 6 hours of triage registration. The diagnostic accuracy of NEWS2+PCT was compared with that of NEWS2, PCT and qSOFA using Receiver Operating Characteristics analysis. 1041 patients were enrolled. Sensitivity and specificity for sepsis diagnosis were as follows: 54%/78.8% for NEWS2≥5; 73.4%/58.3% for PCT≥0.5 ng/ml; 70.9%/67.8% for NEWS2+PCT≥5 and 25%/97.3% for qSOFA. The area under the curve of NEWS2+PCT (0.77,95% CI 0.74-0.80) was significantly high-er than that of NEWS2 (0.72,95% CI 0.69-0.75;p=0.04), PCT (0.71,95% CI 0.68-0.75;p=0.01) and qSOFA (0.70,95% CI 0.67-0.73;p<0.001). Adding PCT to NEWS2 improved diagnostic accuracy for sepsis. In crowded ED, the balance between sensitivity and specificity ensured by NEWS2+PCT≥5 can help to promptly identify patients with sepsis without overwhelming staff.
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Ethics Approval
CRediT authorship contribution
Antonella Viola and Veronica Salvatore worked to the study conception and design and obtained the approval of all the co-authors. Material preparation and data collection were performed by all the co-authors. Data analysis was performed by Antonella Viola and Veronica Salvatore. The manuscript was written by Antonella Viola and all co-authors commented on previous versions of it. All co-authors have had the opportunity to review the final manuscript and have provided their permission to publish the manuscript.
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Data Availability Statement
The datasets used and/or analyzed during the current study are available upon reasonable request from the corresponding author.
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