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

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.

RESEARCH AND APPLICATION OF CROP PEST MONITORING AND EARLY WARNING TECHNOLOGY IN CHINA

The importance of food security,especially in combating the problem of acute hunger,has been underscored as a key component of sustainable development.Considering the major challenge of rapidly increasing demands for both food security and safety,the management and control of major pests is urged to secure supplies of major agricultural products.However,owing to global climate change,biological invasion(e.g.,fall armyworm),decreasing agricultural biodiversity,and other factors,a wide range of crop pest outbreaks are becoming more frequent and serious,making China,one of the world’s largest country in terms of agricultural production,one of the primary victims of crop yield loss and the largest pesticide consumer in the world.Nevertheless,the use of science and technology in monitoring and early warning of major crop pests provides better pest management and acts as a fundamental part of an integrated plant protection strategy to achieve the goal of sustainable development of agriculture.This review summarizes the most fundamental information on pest monitoring and early warning in China by documenting the developmental history of research and application,Chinese laws and regulations related to plant protection,and the National Monitoring and Early Warning System,with the purpose of presenting the Chinese model as an example of how to promote regional management of crop pests,especially of cross border pests such as fall armyworm and locust,by international cooperation across pest-related countries.