Predictive Performance of the NEWS‒Lactate and NEWS Towards Mortality or Need for Critical Care Among Patients with Suspicion of Sepsis in the Emergency Department: A Prospective Observational Study

Abstract

We aimed to evaluate the National Early Warning Score-Lactate (NEWS-L) and NEWS to predict 24-hour mortality as the primary outcome. The secondary outcomes were to predict 48-hour, 28-day, and in-hospital mortality rates, and the need for critical care in patient with suspicion of sepsis at the emergency department (ED). Methods: A prospective observational study was performed in patients aged ≥18 years diagnosed with sepsis in the ED from March to November 2021. Area under the receiver operating characteristic curve (AUROC) analyses determined the predictive values of NEWS and NEWS-L for 24-hour mortality. Results: Ninety-two patients were enrolled (mean age 68 years, 48 [52.2%] males). Three (3.2%) patients died within 24 hours and 34 (36.9%) patients needed critical care during the ED stay. The median (interquartile range) NEWS and NEWS-L results were higher in the 24-hour non-survivors versus survivors: 12 (10.5, 12.5) versus 8 (6, 9) (p = 0.024) and 18.7 (15.2, 19.1) versus 10.6 (8.9, 13) (p = 0.036), respectively. The adjusted odds ratio (aOR) was 1.22 for the primary outcome as the NEWS-L increased by 1 unit without statistical significance (p = 0.228). The aOR values for the secondary outcomes ranged from 1.34 to 1.67 with statistical significance. A NEWS-L of 11 and a NEWS of 12 predicted 24-hour mortality with sensitivities/specificities of 100%/56% and 67%/91%, respectively. The AUROC values of NEWS-L for mortality at 24 hours, 48 hours, 28 days, and in-hospital patients, and the need for critical care were 0.860, 0.905, 0.813, 0.839, and 0.837, respectively. Conclusion: NEWS-L is an accurate predictor for 24-hour mortality in septic patients in the ED. NEWS-L performed better than NEWS for each outcome. NEWS-L demonstrated good to excellent performance and was accurate in predicting sepsis related to adverse outcomes.

Prehospital qSOFA, mSOFA, and NEWS2 performance for sepsis prediction: A prospective, multi-center, cohort study

“…Anyway, we can confirm that, for the analysis of infected patients, the AUC for predicting 2-day mortality and consequently immediate probability risk of death, continues to be good, and exceeds that obtained by both qSOFA and NEWS2 in our study, as well as that obtained by other studies. Dadeh et al (22) analyzed the predictive capacity of 2-day mortality NEWS and NEWS-Lactate among infected patients and obtained AUCs of 0.79 and 0.81 respectively, again lower than those obtained by mSOFA. On the other hand, if we analyze the predictive capacity of qSOFA and prehospital NEWS for 30-day mortality, the AUCs decrease slightly, as demonstrated by Silock et al (23) who obtained AUCs of 0.68 for qSOFA and 0.73 for NEWS2, figures much lower than the performance of mSOFA.…”

Modified Rapid Emergency Medicine Score‐Lactate (mREMS‐L) performance to screen non‐anticipated 30‐day‐related‐mortality in emergency department

“…deterioration in patients with different clinical beyond cases of sepsis, in which its use is evident. [26][27][28][29][30] Hence, different studies reported its use in association with other scores: associated to ViEWS, it improves the prognosis of mortality in critical and major trauma patients 16,17 ; when associated to Modified Early Warning Score (MEWS) it improves accuracy with respect to admission to the ICU 29 ; when used with NEWS2, it detects the risk of 2-day in-hospital mortality in the ED setting. 22,31 Although its effectiveness is questionable when it is used indiscriminately among general patients in emergency services, contradictory results are reported between different authors.…”

“…The use of lactate in combination with different EWSs is not new. Since 2013 when Jo et al 21 combined it with ViEWS, numerous studies have tested it in different populations, demonstrating that the use of biomarkers, and specifically lactate, is very useful for identifying clinical deterioration in patients with different clinical conditions beyond cases of sepsis, in which its use is evident 26–30 . Hence, different studies reported its use in association with other scores: associated to ViEWS, it improves the prognosis of mortality in critical and major trauma patients 16,17 ; when associated to Modified Early Warning Score (MEWS) it improves accuracy with respect to admission to the ICU 29 ; when used with NEWS2, it detects the risk of 2‐day in‐hospital mortality in the ED setting 22,31 .…”