NEWS2 versus shock status to stratify antibiotic urgency in patients with suspected sepsis: a retrospective…

Cohort studyThe Lancet. Respiratory medicine· Aug 2026

NEWS2 versus shock status to stratify antibiotic urgency in patients with suspected sepsis: a retrospective, multicentre cohort study.

Chanu Rhee, Mervyn Singer, Theodore R Pak … Michael Klompas

Infectious DiseaseCohort studyClinical practiceQ1IF 9.4

In shock, each hour's delay in antibiotics raised odds of death 15%

NEWS2 versus shock status to stratify antibiotic urgency in patients with suspected sepsis: a retrospective, multicentre cohort study.

Chanu Rhee … Michael Klompas

The Lancet · Aug 2026

Background

The Surviving Sepsis Campaign guidelines stratify antibiotic urgency in suspected sepsis by shock status, recommending treatment within 1 h for patients with shock and within 3 h for possible sepsis without shock.

Purpose

We aimed to compare these strategies for identifying patients in whom antibiotic delays are associated with mortality.

Methods

We conducted a retrospective cohort study between May 31, 2015, and Feb 28, 2024, of adults (age ≥18 years) admitted via the emergency departments of nine hospitals within the Mass General Brigham health-care system (MA, USA) and treated for suspected infection, defined as blood culture sampling and intravenous antibiotic administration within 6 h of emergency department arrival.

n = 593 patients

OR 1·15

Results

OR 1·15

each hour of delay before antibiotics raised the odds of dying

n = 593 patients

More results

The final analysis cohort included 71 593 patients who contributed 99 667 encounters (52 835 [53%] male, 46 828 [47%] female).

4867 (4·9%) encounters had shock.

No association was observed in encounters with NEWS2+ scores less than 7.

“

Conclusion · 1 of 2

The NICE-defined high-risk NEWS2 category (scores ≥7) identified patients in whom each additional hour to antibiotic administration was associated with increased mortality, including many without shock, whereas no association was observed for lower NEWS2 scores.

Conclusion · 2 of 2

These findings suggest that NEWS2 might better target urgent antibiotic therapy beyond shock-based assessment alone.

NEWS2 versus shock status to stratify antibiotic urgency in patients with suspected sepsis: a retrospective, multicentre cohort study.

NEWS2 versus shock status to stratify antibiotic urgency in patients with suspected sepsis: a retrospective, multicentre cohort study.

Related papers