The predictive value of the modified early warning score with rapid lactate level (ViEWS-L) for mortality in patients of age 65 or older visiting the emergency department

Abstract

The purpose of this study is to detect the predictive power of the modified early warning score with rapid lactate level (ViEWS-L) on mortality in critical patients over the age of 65 years admitted to the emergency department (ED). A total of 616 non-traumatic patients admitted to the Uludag University Faculty of Medicine ED who were 65 years of age or older were included in this study (Ethics board number: 2015-4/8). In this prospective study; the ViEWS-L score of the patients were calculated. The results have been evaluated with rate of mortality in the first 24 h starting from submission. The area under the ROC curve was found 0.872 and the cut-off value to detect mortality was found 10.83 for the ViEWS-L score. In the model obtained by the univariate binary logistic regression analysis, ViEWS-L score was found statistically significant and it was determined that mortality risk increased 1.286 times for each unit increase in the score of ViEWS-L score. As a result of this research, it was found that ViEWS-L scoring system is effective in determining the mortality of 65 years and older patients.

Prehospital Point-Of-Care Lactate Increases the Prognostic Accuracy of National Early Warning Score 2 for Early Risk Stratification of Mortality: Results of a Multicenter, Observational Study

“…The sample size calculation was performed using an area under the curve (AUC) of the expected receiver operating characteristic (ROC) of 90% with a confidence level of 99% and an accuracy of 1%, with 2543 subjects. We estimated a follow-up loss in 5%, so the estimated final sample size was 2677 subjects, for an early mortality rate of 4%, in line with similar studies [7,11,18].…”

“…It is common to find studies that analyze the use of EWS and lactate in people with acute disease [18,19,28] and studies that specifically analyze the association between the NEWS2 and lactate [20,21,29,30]. However, it is rather uncommon to find studies focused on the prehospital context [31][32][33], especially dealing with the use of the pLA for a further evaluation of risk groups stratified by the NEWS2.…”

“…The use of EWS and biomarkers represents a fundamental tool that enables the systematized evaluation of the patient and can predict possible serious adverse events (SAEs), individualizing the assessment and care of each patient [17]. EWS and biomarkers have been used separately and in combination [18,19]. Specifically, the relationship between the NEWS2 and lactate has been analyzed in diverse clinical contexts [20][21][22].…”

Role of Biomarkers in the Prediction of Serious Adverse Events after Syncope in Prehospital Assessment: A Multi-Center Observational Study

“…Our results are in line with studies that have analyzed prognostic scores and mortality data for syncope patients [24][25][26][27][28], although those had been conducted in the ED. Other work has analyzed the combined use of EWSs and lactate in other contexts [29][30][31][32] and also obtained areas under the ROC curve between 0.830 and 0.914 for detecting two-day mortality. Our data confirm and add to previous studies, being the only study specifically developed to detect patients with syncope at high risk in the prehospital context, which provides very useful information on the need for prehospital advanced life support or ICU.…”

Is age-adjusted Modified Early Warning Score upon admission a relevant prognostic tool for final outcome?

“…In the most recent study EWS was also proposed as a prognostic tool, but further validation is necessary [8]. Addition of laboratory findings to increase the value of clinical scores has been considered [9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Since our respiratory High Dependency Unit (HDU) is mainly used for treating the patients diagnosed with pneumonia and sepsis, severe COPD exacerbation and pulmonary thromboembolism, we decided to test lactate, base excess (BE), and age in, addition to MEWS, as predictors of final outcome.…”