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Persistently elevated early warning scores and lactate identifies patients at high risk of mortality in suspected sepsis

Hargreaves, Duncan Sebastian, de Carvalho, Joshua Lucas Jarman, Smith, Laura, Picton, Graham, Venn, Richard and Hodgson, Luke Eliot (2020) Persistently elevated early warning scores and lactate identifies patients at high risk of mortality in suspected sepsis European Journal of Emergency Medicine, 27 (2). pp. 125-131.

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Abstract

Objective In the UK, the National Early Warning Score (NEWS) is recommended as part of screening for suspicion of sepsis. Is a change in NEWS a better predictor of mortality than an isolated score when screening for suspicion of sepsis?. Methods A prospectively gathered cohort of 1233 adults brought in by ambulance to two UK nonspecialist hospitals, with suspicion of sepsis at emergency department (ED) triage (2015–2017) was analysed. Associations with 30-day mortality and ICU admission rate were compared between groups with an isolated NEWS ≥5 points prehospital and those with persistently elevated NEWS prehospital, in ED and at ward admission. The effect of adding the ED (venous or arterial) lactate was also assessed. Results Mortality increased if the NEWS persisted ≥5 at ED arrival 22.1% vs. 10.2% [odds ratio (OR) 2.5 (1.6–4.0); P < 0.001]. Adding an ED lactate ≥2 mmol/L was associated with an increase in mortality greater than for NEWS alone [32.2% vs. 13.3%, OR 3.1 (2.2–4.1); P < 0.001], and increased ICU admission [13.9% vs. 3.7%, OR 3.1 (2.2–4.3); P < 0.001]. If NEWS remained ≥5 at ward admission (predominantly within 4 h of ED arrival), mortality was 32.1% vs. 14.3%, [OR 2.8 (2.1–3.9); P < 0.001] and still higher if accompanied by an elevated ED lactate [42.1% vs. 16.4%, OR 3.7 (2.6–5.3); P < 0.001]. Conclusion Persistently elevated NEWS, from prehospital through the ED to the time of ward admission, combined with an elevated ED lactate identifies patients with suspicion of sepsis at highest risk of in-hospital mortality.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences
Authors :
NameEmailORCID
Hargreaves, Duncan Sebastian
de Carvalho, Joshua Lucas Jarman
Smith, Laural.m.smith@surrey.ac.uk
Picton, Graham
Venn, Richard
Hodgson, Luke Eliot
Date : April 2020
DOI : 10.1097/MEJ.0000000000000630
OA Location : https://journals.lww.com/euro-emergencymed/Abstract/2020/04000/Persistently_elevated_early_warning_scores_and.13.aspx
Copyright Disclaimer : Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Uncontrolled Keywords : ambulance, early warning score, lactate, lactic acid, hospital mortality, National early warning score, screening, sepsis, suspicion of sepsis
Depositing User : James Marshall
Date Deposited : 10 Jun 2020 09:17
Last Modified : 18 Jul 2020 02:08
URI: http://epubs.surrey.ac.uk/id/eprint/857316

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