Infection and Drug Resistance (Jul 2022)
National Early Warning Score and New-Onset Atrial Fibrillation for Predicting In-Hospital Mortality or Transfer to the Intensive Care Unit in Emergency Department Patients with Suspected Bacterial Infections
Abstract
Finn Erland Nielsen,1,2 Christina Seefeldt Stæhr,1 Rune Husås Sørensen,2 Thomas Andersen Schmidt,3,4 S M Osama Bin Abdullah2,5 1Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark; 2Department of Emergency Medicine, Slagelse Hospital, Slagelse, Denmark; 3Department of Emergency Medicine, Nordsjaellands Hospital, Hilleroed, Denmark; 4Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; 5Department of Internal Medicine, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, DenmarkCorrespondence: Finn Erland Nielsen, Department of Emergency Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark, Tel +45 26822753, Fax +45 38639863, Email [email protected]: There are conflicting data regarding the role of the National Early Warning Score 2 (NEWS2) in predicting adverse outcomes in patients with infectious diseases. New-onset atrial fibrillation (NO-AF) has been suggested as a sepsis-defining sign of organ dysfunction. This study aimed to examine the prognostic accuracy of NEWS2 and whether NO-AF can provide prognostic information in emergency department (ED) patients with suspected bacterial infections.Patients and Methods: Secondary analyses of data from a prospective observational cohort study of adults admitted in a 6-month period with suspected bacterial infections. We used the composite endpoint of in-hospital mortality or transfer to the intensive care unit as the primary outcome. The prognostic accuracy of NEWS2 and quick sequential organ failure assessment (qSOFA) and covariate-adjusted area under the receiver operating curves (AAUROC) were used to describe the performance of the scores. Logistic regression analysis was used to examine the association between NO-AF and the composite endpoint.Results: A total of 2055 patients were included in this study. The composite endpoint was achieved in 198 (9.6%) patients. NO-AF was observed in 80 (3.9%) patients. The sensitivity and specificity for NEWS2 ≥ 5 were 70.2% (63.3– 76.5) and 60.2% (57.9– 62.4), respectively, and those for qSOFA ≥ 2 were 26.3% (20.3– 33.0) and 91.0% (89.6– 92.3), respectively. AAUROC for NEWS2 and qSOFA were 0.68 (0.65– 0.73) and 0.63 (0.59– 0.68), respectively. The adjusted odds ratio for achieving the composite endpoint in 48 patients with NO-AF who fulfilled the NEWS2 ≥ 5 criteria was 2.71 (1.35– 5.44).Conclusion: NEWS2 had higher sensitivity but lower specificity and better, albeit poor, discriminative ability to predict the composite endpoint compared to qSOFA. NO-AF can provide important prognostic information.Keywords: infectious disease, sepsis, predictive ability, National Early Warning Score 2, NEWS2, quick sequential organ failure assessment, qSOFA, new-onset atrial fibrillation
