BACKGROUND:To evaluate the accuracy of National Early Warning Score(NEWS)in predicting clinical outcomes(28-day mortality,intensive care unit[ICU]admission,and mechanical ventilation use)for septic patients with commu...BACKGROUND:To evaluate the accuracy of National Early Warning Score(NEWS)in predicting clinical outcomes(28-day mortality,intensive care unit[ICU]admission,and mechanical ventilation use)for septic patients with community-acquired pneumonia(CAP)compared with other commonly used severity scores(CURB65,Pneumonia Severity Index[PSI],Sequential Organ Failure Assessment[SOFA],quick SOFA[qSOFA],and Mortality in Emergency Department Sepsis[MEDS])and admission lactate level.METHODS:Adult patients diagnosed with CAP admitted between January 2017 and May 2019 with admission SOFA≥2 from baseline were enrolled.Demographic characteristics were collected.The primary outcome was the 28-day mortality after admission,and the secondary outcome included ICU admission and mechanical ventilation use.Outcome prediction value of parameters above was compared using receiver operating characteristics(ROC)curves.Cox regression analyses were carried out to determine the risk factors for the 28-day mortality.Kaplan-Meier survival curves were plotted and compared using optimal cut-off values of qSOFA and NEWS.RESULTS:Among the 340 enrolled patients,90 patients were dead after a 28-day follow-up,62 patients were admitted to ICU,and 84 patients underwent mechanical ventilation.Among single predictors,NEWS achieved the largest area under the receiver operating characteristic(AUROC)curve in predicting the 28-day mortality(0.861),ICU admission(0.895),and use of mechanical ventilation(0.873).NEWS+lactate,similar to MEDS+lactate,outperformed other combinations of severity score and admission lactate in predicting the 28-day mortality(AUROC 0.866)and ICU admission(AUROC 0.905),while NEWS+lactate did not outperform other combinations in predicting mechanical ventilation(AUROC 0.886).Admission lactate only improved the predicting performance of CURB65 and qSOFA in predicting the 28-day mortality and ICU admission.CONCLUSIONS:NEWS could be a valuable predictor in septic patients with CAP in emergency departments.Admission lactate did not predict well the outcomes or improve the severity scores.A qSOFA≥2 and a NEWS≥9 were strongly associated with the 28-day mortality,ICU admission,and mechanical ventilation of septic patients with CAP in the emergency departments.展开更多
AIM To assess the performance and clinical relevance of the Early Warning Scoring(EWS)system at the Intermediate Care Unit(IMCU).METHODS This cohort study used all the Vital PAC EWS(Vi EWS)scores collected during each...AIM To assess the performance and clinical relevance of the Early Warning Scoring(EWS)system at the Intermediate Care Unit(IMCU).METHODS This cohort study used all the Vital PAC EWS(Vi EWS)scores collected during each nursing shift from 2014through 2016 at the mixed surgical IMCU of an academic teaching hospital.Clinical deterioration defined as transfer to the Intensive Care Unit(ICU)or mortality within 24 h was the primary outcome of interest.RESULTS A total of 9113 aggregated Vi EWS scores were obtained from 2113 admissions.The incidence of the combined outcome was 272(3.0%).The area under the curve of the Vi EWS was 0.72(CI:0.69-0.75).Using a threshold value of six,the sensitivity was 68%with a positive predictive value of 5%and a number needed to trigger(e.g.,false alarms)of 19%.CONCLUSION The Vi EWS at the IMCU has a discriminative performance that is considerably lower than at the hospital ward.The number of false alarms is high,which may result in alarm fatigue.Therefore,use of the Vi EWS in its current form at the IMCU should be reconsidered.展开更多
目的:评估国家预警评分系统(national early warning score,NEWS)联合白蛋白预测急性心力衰竭患者不良预后的价值。方法:选取2015年1月至2020年12月入住宣武医院急诊重症监护室的急性心力衰竭患者共524例,按住院期间的预后情况分为预后...目的:评估国家预警评分系统(national early warning score,NEWS)联合白蛋白预测急性心力衰竭患者不良预后的价值。方法:选取2015年1月至2020年12月入住宣武医院急诊重症监护室的急性心力衰竭患者共524例,按住院期间的预后情况分为预后不良组及无预后不良组,收集两组患者的一般临床及生化指标,采用单因素、多因素统计分析,筛选预后不良的独立危险因素,结合ROC曲线计算敏感性、特异性。结果:524例患者中有278例发生预后不良,与无预后不良组患者相比,单因素分析显示预后不良组患者年龄较小,白蛋白水平较低,NEWS更高,NYHA分级较高(均P<0.05);多因素Logistic回归结果显示,NEWS越高,心力衰竭患者发生不良预后的风险越大,具有统计学意义(OR=1.34,95%CI:1.21~1.50,P<0.001);白蛋白水平越低,心力衰竭患者发生不良预后的风险越大,差异有统计学意义(OR=0.94,95%CI:0.88~1.00,P=0.038),NYHA分级越高,心力衰竭患者发生不良预后的风险越大,具有统计学意义(OR=13.01,95%CI:8.39~20.19,P<0.001)。绘制ROC曲线,预测不良预后的曲线下面积NEWS为0.77,白蛋白为0.61,NEWS联合白蛋白为0.79,联合指标的曲线下面积优于单独NEWS评分(Z=2.112,P=0.035)。结论:NEWS联合白蛋白在急性心力衰竭患者的不良预后中有一定的预测价值。展开更多
目的评估国家早期预警评分2(NEWS2)联合动脉血乳酸水平预测重症社区获得性肺炎(SCAP)患者短期预后的价值。方法回顾性收集某三甲医院2017年5月—2022年5月收治的成人SCAP住院患者的中性粒细胞与淋巴细胞比值(NLR)、氧合指数、NEWS 2评...目的评估国家早期预警评分2(NEWS2)联合动脉血乳酸水平预测重症社区获得性肺炎(SCAP)患者短期预后的价值。方法回顾性收集某三甲医院2017年5月—2022年5月收治的成人SCAP住院患者的中性粒细胞与淋巴细胞比值(NLR)、氧合指数、NEWS 2评分及急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)等资料。根据28天预后分为存活组和死亡组,比较组间差异,并分析主要指标的相关性。采用多因素logistic回归分析和受试者工作特征(ROC)曲线分析NEWS2评分、乳酸以及两者联合对SCAP患者死亡风险的预测价值。结果共入组97例SCAP患者,存活65例,死亡32例,28天病死率32.99%。与存活组比较,死亡组患者入院时NEWS2评分、APACHEⅡ评分、降钙素原(PCT)、NLR及血乳酸均较高,CD3^(+)CD4^(+)T淋巴细胞、氧合指数明显降低,差异均有统计学意义(均P<0.05)。血乳酸与NEWS2评分、APACHEⅡ评分均具有较好的相关性(r值分别为0.411、0.709,均P<0.01)。多因素logistic回归分析显示,NEWS2评分和血乳酸为SCAP患者28天死亡的独立危险因素(OR=1.422,95%CI:1.043~1.938;OR=1.635,95%CI:1.072~2.492,均P<0.05)。ROC曲线分析显示,与传统指标APACHEⅡ评分相比较,NEWS2评分、血乳酸对SCAP患者28天死亡的预测价值良好[曲线下面积(AUC)分别为0.740、0.721 VS 0.772,Z值为0.506、1.141,均P>0.05];当NEWS2评分、血乳酸最佳截断值分别是7分、1.96 mmol/L时,灵敏度分别为81.3%、68.7%,特异度分别为63.1%、75.4%。NEWS2评分联合血乳酸显示出更高的预测价值(AUC为0.776 VS 0.772),并且具有较高的灵敏度(84.4%)和特异度(70.8%)。结论入院时NEWS2评分、血乳酸是SCAP患者28天死亡的独立危险因素,均具有较高的预测价值;NEWS2评分联合血乳酸预测SCAP患者短期预后的价值更高,优于单个评分。展开更多
目的：探讨英国国家早期预警评分（ national early warning score， NEWS）对我国急诊老年患者死亡的预测价值和可行性。方法采用多中心前瞻性队列研究，对我国不同地区的九所三甲医院急诊就诊的老年患者使用NEWS预测死亡率。结果2013...目的：探讨英国国家早期预警评分（ national early warning score， NEWS）对我国急诊老年患者死亡的预测价值和可行性。方法采用多中心前瞻性队列研究，对我国不同地区的九所三甲医院急诊就诊的老年患者使用NEWS预测死亡率。结果2013－10～2014－05共收集了1528例患者，主要观察结果是就诊期间的死亡。 NEWS≥7分与死亡明显相关（ OR＝10.139，95％CI＝5．795～17．737）。 NEWS、MEWS对急诊老年患者预后预测概率的 ROC 曲线下面积[AUC（95％CI）]分别为0．834（0．778～0．890） vs 0．753（0．678～0.828），两者比较差异有统计学意义（ P＝0．045）。结论 NEWS可以较好地预测我国急诊老年患者预后，且优于急诊目前常用的MEWS。展开更多
基金Capital Clinical Characteristic Application Research of Beijing Municipal Science & Technology Commission (Z171100001017057).
文摘BACKGROUND:To evaluate the accuracy of National Early Warning Score(NEWS)in predicting clinical outcomes(28-day mortality,intensive care unit[ICU]admission,and mechanical ventilation use)for septic patients with community-acquired pneumonia(CAP)compared with other commonly used severity scores(CURB65,Pneumonia Severity Index[PSI],Sequential Organ Failure Assessment[SOFA],quick SOFA[qSOFA],and Mortality in Emergency Department Sepsis[MEDS])and admission lactate level.METHODS:Adult patients diagnosed with CAP admitted between January 2017 and May 2019 with admission SOFA≥2 from baseline were enrolled.Demographic characteristics were collected.The primary outcome was the 28-day mortality after admission,and the secondary outcome included ICU admission and mechanical ventilation use.Outcome prediction value of parameters above was compared using receiver operating characteristics(ROC)curves.Cox regression analyses were carried out to determine the risk factors for the 28-day mortality.Kaplan-Meier survival curves were plotted and compared using optimal cut-off values of qSOFA and NEWS.RESULTS:Among the 340 enrolled patients,90 patients were dead after a 28-day follow-up,62 patients were admitted to ICU,and 84 patients underwent mechanical ventilation.Among single predictors,NEWS achieved the largest area under the receiver operating characteristic(AUROC)curve in predicting the 28-day mortality(0.861),ICU admission(0.895),and use of mechanical ventilation(0.873).NEWS+lactate,similar to MEDS+lactate,outperformed other combinations of severity score and admission lactate in predicting the 28-day mortality(AUROC 0.866)and ICU admission(AUROC 0.905),while NEWS+lactate did not outperform other combinations in predicting mechanical ventilation(AUROC 0.886).Admission lactate only improved the predicting performance of CURB65 and qSOFA in predicting the 28-day mortality and ICU admission.CONCLUSIONS:NEWS could be a valuable predictor in septic patients with CAP in emergency departments.Admission lactate did not predict well the outcomes or improve the severity scores.A qSOFA≥2 and a NEWS≥9 were strongly associated with the 28-day mortality,ICU admission,and mechanical ventilation of septic patients with CAP in the emergency departments.
文摘AIM To assess the performance and clinical relevance of the Early Warning Scoring(EWS)system at the Intermediate Care Unit(IMCU).METHODS This cohort study used all the Vital PAC EWS(Vi EWS)scores collected during each nursing shift from 2014through 2016 at the mixed surgical IMCU of an academic teaching hospital.Clinical deterioration defined as transfer to the Intensive Care Unit(ICU)or mortality within 24 h was the primary outcome of interest.RESULTS A total of 9113 aggregated Vi EWS scores were obtained from 2113 admissions.The incidence of the combined outcome was 272(3.0%).The area under the curve of the Vi EWS was 0.72(CI:0.69-0.75).Using a threshold value of six,the sensitivity was 68%with a positive predictive value of 5%and a number needed to trigger(e.g.,false alarms)of 19%.CONCLUSION The Vi EWS at the IMCU has a discriminative performance that is considerably lower than at the hospital ward.The number of false alarms is high,which may result in alarm fatigue.Therefore,use of the Vi EWS in its current form at the IMCU should be reconsidered.
文摘目的:评估国家预警评分系统(national early warning score,NEWS)联合白蛋白预测急性心力衰竭患者不良预后的价值。方法:选取2015年1月至2020年12月入住宣武医院急诊重症监护室的急性心力衰竭患者共524例,按住院期间的预后情况分为预后不良组及无预后不良组,收集两组患者的一般临床及生化指标,采用单因素、多因素统计分析,筛选预后不良的独立危险因素,结合ROC曲线计算敏感性、特异性。结果:524例患者中有278例发生预后不良,与无预后不良组患者相比,单因素分析显示预后不良组患者年龄较小,白蛋白水平较低,NEWS更高,NYHA分级较高(均P<0.05);多因素Logistic回归结果显示,NEWS越高,心力衰竭患者发生不良预后的风险越大,具有统计学意义(OR=1.34,95%CI:1.21~1.50,P<0.001);白蛋白水平越低,心力衰竭患者发生不良预后的风险越大,差异有统计学意义(OR=0.94,95%CI:0.88~1.00,P=0.038),NYHA分级越高,心力衰竭患者发生不良预后的风险越大,具有统计学意义(OR=13.01,95%CI:8.39~20.19,P<0.001)。绘制ROC曲线,预测不良预后的曲线下面积NEWS为0.77,白蛋白为0.61,NEWS联合白蛋白为0.79,联合指标的曲线下面积优于单独NEWS评分(Z=2.112,P=0.035)。结论:NEWS联合白蛋白在急性心力衰竭患者的不良预后中有一定的预测价值。
文摘目的评估国家早期预警评分2(NEWS2)联合动脉血乳酸水平预测重症社区获得性肺炎(SCAP)患者短期预后的价值。方法回顾性收集某三甲医院2017年5月—2022年5月收治的成人SCAP住院患者的中性粒细胞与淋巴细胞比值(NLR)、氧合指数、NEWS 2评分及急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)等资料。根据28天预后分为存活组和死亡组,比较组间差异,并分析主要指标的相关性。采用多因素logistic回归分析和受试者工作特征(ROC)曲线分析NEWS2评分、乳酸以及两者联合对SCAP患者死亡风险的预测价值。结果共入组97例SCAP患者,存活65例,死亡32例,28天病死率32.99%。与存活组比较,死亡组患者入院时NEWS2评分、APACHEⅡ评分、降钙素原(PCT)、NLR及血乳酸均较高,CD3^(+)CD4^(+)T淋巴细胞、氧合指数明显降低,差异均有统计学意义(均P<0.05)。血乳酸与NEWS2评分、APACHEⅡ评分均具有较好的相关性(r值分别为0.411、0.709,均P<0.01)。多因素logistic回归分析显示,NEWS2评分和血乳酸为SCAP患者28天死亡的独立危险因素(OR=1.422,95%CI:1.043~1.938;OR=1.635,95%CI:1.072~2.492,均P<0.05)。ROC曲线分析显示,与传统指标APACHEⅡ评分相比较,NEWS2评分、血乳酸对SCAP患者28天死亡的预测价值良好[曲线下面积(AUC)分别为0.740、0.721 VS 0.772,Z值为0.506、1.141,均P>0.05];当NEWS2评分、血乳酸最佳截断值分别是7分、1.96 mmol/L时,灵敏度分别为81.3%、68.7%,特异度分别为63.1%、75.4%。NEWS2评分联合血乳酸显示出更高的预测价值(AUC为0.776 VS 0.772),并且具有较高的灵敏度(84.4%)和特异度(70.8%)。结论入院时NEWS2评分、血乳酸是SCAP患者28天死亡的独立危险因素,均具有较高的预测价值;NEWS2评分联合血乳酸预测SCAP患者短期预后的价值更高,优于单个评分。
文摘目的：探讨英国国家早期预警评分（ national early warning score， NEWS）对我国急诊老年患者死亡的预测价值和可行性。方法采用多中心前瞻性队列研究，对我国不同地区的九所三甲医院急诊就诊的老年患者使用NEWS预测死亡率。结果2013－10～2014－05共收集了1528例患者，主要观察结果是就诊期间的死亡。 NEWS≥7分与死亡明显相关（ OR＝10.139，95％CI＝5．795～17．737）。 NEWS、MEWS对急诊老年患者预后预测概率的 ROC 曲线下面积[AUC（95％CI）]分别为0．834（0．778～0．890） vs 0．753（0．678～0.828），两者比较差异有统计学意义（ P＝0．045）。结论 NEWS可以较好地预测我国急诊老年患者预后，且优于急诊目前常用的MEWS。
