Predicting severe outcomes using national early warning score (NEWS) in patients identified by a rapid response system: a retrospective cohort study

AbstractThere are insufficient data in managing patients at high risk of deterioration. We aimed to investigate that national early warning score (NEWS) could predict severe outcomes in patients identified by a rapid response system (RRS), focusing on the patient’s age. We conducted a retrospective cohort study from June 2019 to December 2020. Outcomes were unplanned intensive care unit (ICU) admission, ICU mortality, and in-hospital mortality. We analyzed the predictive ability of NEWS using receiver operating characteristics (ROC) curve and the effect of NEWS parameters using multivariable logistic regression. A total of 2,814 RRS activations were obtained. The predictive ability of NEWS for unplanned ICU admission and in-hospital mortality was fair but was poor for ICU mortality. The predictive ability of NEWS showed no differences between patients aged 80 years or older and under 80 years. However, body temperature affected in-hospital mortality for patients aged 80 years or older, and the inverse effect on unplanned ICU admission was observed. The NEWS showed fair predictive ability for unplanned ICU admission and in-hospital mortality among patients identified by the RRS. The different presentations of patients 80 years or older should be considered in implementing the RRS.

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Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study

Canadian Journal of Kidney Health and Disease ◽

10.1177/20543581211027759 ◽

2021 ◽

Vol 8 ◽

pp. 205435812110277

Author(s):

Tyler Pitre ◽

Angela (Hong Tian) Dong ◽

Aaron Jones ◽

Jessica Kapralik ◽

Sonya Cui ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Cohort Study ◽

Hospital Mortality ◽

Disease Severity ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Kidney Injury ◽

Icu Admission

Background: The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population. Objective: To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI. Design: Retrospective cohort study from a registry of patients with COVID-19. Setting: Three community and 3 academic hospitals. Patients: A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021. Measurements: Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality. Methods: We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality. Results: Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]). Limitations: Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences. Conclusions: Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification. Trial registration: The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.

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Predicting mortality in patients with suspected sepsis at the Emergency Department; A retrospective cohort study comparing qSOFA, SIRS and National Early Warning Score

PLoS ONE ◽

10.1371/journal.pone.0211133 ◽

2019 ◽

Vol 14 (1) ◽

pp. e0211133 ◽

Cited By ~ 18

Author(s):

Anniek Brink ◽

Jelmer Alsma ◽

Rob Johannes Carel Gerardus Verdonschot ◽

Pleunie Petronella Marie Rood ◽

Robert Zietse ◽

...

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Early Warning ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Early Warning Score ◽

Suspected Sepsis ◽

National Early Warning Score

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The effectiveness of a national early warning score as a triage tool for activating a rapid response system in an outpatient setting

Medicine ◽

10.1097/md.0000000000018475 ◽

2019 ◽

Vol 98 (52) ◽

pp. e18475 ◽

Cited By ~ 2

Author(s):

Jun Ehara ◽

Eiji Hiraoka ◽

Hsiang-Chin Hsu ◽

Toru Yamada ◽

Yosuke Homma ◽

...

Keyword(s):

Early Warning ◽

Outpatient Setting ◽

Rapid Response ◽

Early Warning Score ◽

Rapid Response System ◽

Response System ◽

National Early Warning Score

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Poor specificity of National Early Warning Score (NEWS) in spinal cord injuries (SCI) population: a retrospective cohort study

Spinal Cord ◽

10.1038/s41393-019-0330-0 ◽

2019 ◽

Vol 58 (2) ◽

pp. 165-173 ◽

Cited By ~ 1

Author(s):

Wail A. Ahmed ◽

Alex Rouse ◽

Katy E. Griggs ◽

Johnny Collett ◽

Helen Dawes

Keyword(s):

Spinal Cord ◽

Cohort Study ◽

Early Warning ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Spinal Cord Injuries ◽

Early Warning Score ◽

National Early Warning Score

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Peer review report 2 on “Pre-hospital national early warning score (NEWS) is associated with in-hospital mortality and critical care unit admission: A cohort study”

Annals of Medicine and Surgery ◽

10.1016/j.amsu.2018.03.039 ◽

2018 ◽

Vol 25 ◽

pp. 50

Keyword(s):

Critical Care ◽

Cohort Study ◽

Hospital Mortality ◽

Peer Review ◽

Early Warning ◽

Critical Care Unit ◽

Early Warning Score ◽

National Early Warning Score

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Who Benefits from Aggressive Rapid Response System Treatments Near the End of Life? A Retrospective Cohort Study

The Joint Commission Journal on Quality and Patient Safety ◽

10.1016/j.jcjq.2018.04.001 ◽

2018 ◽

Vol 44 (9) ◽

pp. 505-513 ◽

Cited By ~ 1

Author(s):

Magnolia Cardona ◽

Robin M. Turner ◽

Amanda Chapman ◽

Hatem Alkhouri ◽

Ebony T. Lewis ◽

...

Keyword(s):

Cohort Study ◽

End Of Life ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Rapid Response ◽

Rapid Response System ◽

Response System

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Association Between Phosphate Disturbances and Mortality Among Critically Ill Patients With Sepsis or Septic Shock

10.21203/rs.3.rs-149787/v1 ◽

2021 ◽

Author(s):

Shmeylan Al Harbi ◽

Hasan Al-Dorzi ◽

Albatool Al Meshari ◽

Hani Tamim ◽

Sheryl Ann Abdukahil ◽

...

Keyword(s):

Septic Shock ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Retrospective Cohort ◽

Serum Phosphate ◽

The Other ◽

Icu Mortality ◽

Icu Admission ◽

Surgical Icus

Abstract Objective: The aim of this study is to examine the association of hypophosphatemia and hyperphosphatemia on the first day of ICU admission with mortality in septic critically ill patients. Methods: In this retrospective cohort study, all adult patients who were admitted to medical-surgical ICUs between 2014 and 2017 with sepsis or septic shock were categorized as having hypophosphatemia, hyperphosphatemia or based on day 1 serum phosphate values. We compared the clinical characteristics and outcomes between the three groups. We used multivariate analysis to examine the association of hypophosphatemia and hyperphosphatemia with these outcomes.Results: Of the 1422 patients enrolled in the study, 188 (13%) had hypophosphatemia, 865 (61%) normophosphatemia and 369 (26%) had hyperphosphatemia. Among the three groups, the patients in the hyperphosphatemia group had significantly lower GCS, higher APACHE II scores, higher serum creatinine, increased use of vasopressors, and required mechanical ventilation with lower PaO2/FiO2 ratio compared with the other two groups. In addition, hyperphosphatemia group also showed significantly higher ICU mortality and hospital mortality in comparison to the other two groups. Conclusion: Hyperphosphatemia and not hypophosphatemia on the first ICU admission day was associated with an increase in the ICU and hospital mortality in septic critically ill patients.

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Outcome prediction value of National Early Warning Score in septic patients with community-acquired pneumonia in emergency department: A single-center retrospective cohort study

World Journal of Emergency Medicine ◽

10.5847/wjem.j.1920-8642.2020.04.002 ◽

2020 ◽

Vol 11 (4) ◽

pp. 206

Author(s):

Hai-jiang Zhou

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Early Warning ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Outcome Prediction ◽

Community Acquired Pneumonia ◽

Early Warning Score ◽

Single Center ◽

National Early Warning Score

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The protective association of endogenous immunoglobulins against sepsis mortality is restricted to patients with moderate organ failure

10.1101/116665 ◽

2017 ◽

Author(s):

Ignacio Martin-Loeches ◽

Arturo Muriel-Bombín ◽

Ricard Ferrer ◽

Antonio Artigas ◽

Jordi Sole-Violan ◽

...

Keyword(s):

Hospital Mortality ◽

Organ Failure ◽

Mortality Risk ◽

Multivariate Logistic Regression Analysis ◽

Predictive Ability ◽

Simultaneous Presence ◽

Icu Mortality ◽

Icu Admission ◽

The Impact ◽

Immunoglobulin Levels

AbstractBackgroundpre-evaluation of endogenous immunoglobulin levels is a potential strategy to improve the results of intravenous immunoglobulins in sepsis, but more work has to be done to identify those patients who could benefit the most from this treatment. The objective of this study was to evaluate the impact of endogenous immunoglobulins on the mortality risk in sepsis depending on disease severity.Methodsthis was a retrospective observational study including 278 patients admitted to the ICU with sepsis fulfilling the SEPSIS-3 criteria, coming from the Spanish GRECIA and ABISS-EDUSEPSIS cohorts. Patients were distributed into two groups depending on their Sequential Organ Failure Assessment score al ICU admission (SOFA < 8, n = 122 and SOFA ≥ 8, n = 156) and the association between immunoglobulin levels at ICU admission with mortality was studied in each group by Kaplan Meier and multivariate logistic regression analysis.ResultsICU / hospital mortality in the SOFA < 8 group was 14.8% / 23.0%, compared to 30.1 % / 35.3% in the SOFA ≥ 8 group. In the group with SOFA < 8, the simultaneous presence of total IgG <407 mg/dl, IgM < 43 mg/dl and IgA < 219 mg/dl was associated to a reduction in the survival mean time of 6.6 days in the first 28 days, and was a robust predictor of mortality risk either during the acute and the post-acute phase of the disease (OR for ICU mortality: 13.79; OR for hospital mortality: 7.98). This predictive ability remained in the absence of prior immunosupression (OR for ICU mortality: 17.53; OR for hospital mortality: 5.63). Total IgG <407 mg/dl or IgG1 < 332 mg/dl was also an independent predictor of ICU mortality in this group. In contrast, in the SOFA ≥ 8 group, we found no immunoglobulin thresholds associated to neither ICU nor to hospital mortality.Conclusionsendogenous immunoglobulin levels may have a different impact on the mortality risk of sepsis patients based on their severity. In patients with moderate organ failure, the simultaneous presence of low levels of IgG, IgA and IgM was a consistent predictor of both acute and post-acute mortality.

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