doiSerbia

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

Obradović Dušanka (Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia + University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia), dusanka.obradovic@mf.uns.ac.rs; dudaob@yahoo.com
Joveš Biljana (Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia + University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia)
Vujović Ivana (Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia)
Vukoja Marija (Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia + University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia)
Stefanović Srđan (Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia)
Sovilj-Gmizić Stanislava (Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia)

Introduction. Early warning scoring systems are important for timely identification of the critically ill, but are they a relevant prognostic tool? Our objective was to test if Modified Early Warning Score (MEWS), lactate, and base excess (BE) have any prognostic value in high dependency unit patients. Methods. This was a prospective observational study that included 364 patients treated at a respiratory high dependency unit. The values of MEWS, lactate, and BE at admission were recorded with patients’ age, sex, and comorbidities. Negative outcome was defined as death or transfer to the intensive care unit. Independent predictors of negative outcome were identified with the use of multivariable logistic regression. Results. Of 369 patients, 203 (55%) were male. Mean age was 62 ± 16. There were 138 (37.4%) patients with negative outcome: 27.37% died, while 10.03% patients required intensive care unit transfer. The median length of hospital stay was 13 days (IQR 7–15). Patients with negative outcome had a significantly higher MEWS (3.68 ± 1.965 vs. 4.57 ± 2.33, p < 0.001), lower BE (-0.139 ± 7.48 vs. -3.751 ± 6.159, p < 0.001), and a higher lactate (2.299 ± 2.350 vs. 3.498 ± 3.578, p < 0.001). MEWS ≥ 4 (OR 1.90, CI 1.082–3.340, p = 0.026) was the only independent predictor of mortality. Area under the curve (AUC) for MEWS with regard to in-hospital mortality prediction was 0.633 (95% CI 0.569–0.697). When age was added to MEWS, the AUC was 0.76 (95% CI 0.707–0.814). Conclusion. Our findings support the prognostic value of MEWS for final outcome of patients admitted to the high dependency unit.

Keywords: MEWS, lactate, BE, outcome