Acil yoğun bakım ünitesine kabul edilen hastaların hastane içi mortalite tahmininde news-2 ve msofa skorlarının karşılaştırılması
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2023
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info:eu-repo/semantics/openAccess
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Giriş Yoğun bakım ünitesinde (YBÜ) hasta sonuçlarının geliştirilmesi için prognoz tahmininde skorlama sistemlerinin kullanılması önemlidir. Gelecekteki olası influenza, coronavirüs pandemileri ve insan kaynaklı afetlerde YBÜ kapasiteleri aşılabilir. Yoğun bakımdan en çok fayda görecek ve dolayısıyla sağkalımı en yüksek hastaların belirlenmesi hastaların triyajına katkıda bulunabilir. Hastane ve YBÜ'de hastaların triyajı ve mortalite tahmininde çok sayıda skorlama sistemleri kullanılmaktadır. Ancak, yoğun iş gücü ve kaynak tüketimine neden olan kompleks skorlama sistemlerinin uygulanması zordur. Ulusal Erken Uyarı Sistemi (NEWS-2) ve Modifiye Ardışık Organ Yetmezlik Değerlendirmesi (mSOFA) skorlamaları neredeyse tamamen hastaların rutin takiplerinde değerlendirilen vital bulguları temel almaktadır. YBÜ hastalarında prognoz tahmininde NEWS-2'nin performansını değerlendiren çalışmalar sınırlıdır. Bu çalışmanın amacı görece yeni bir skorlama sistemi olan NEWS-2'nin acil YBÜ hastalarında mortalite tahminindeki rolünün gösterilmesi ve iyi bilinen bir skorlama sistemi olan mSOFA ile karşılaştırılmasıdır. Gereç ve yöntem Çalışmamıza üçüncü basamak bir hastanenin acil YBÜ bölümüne Aralık 2021 ile Haziran 2022 tarihleri arasında başvuran 393 hasta prospektif olarak dahil edildi. Hastaların YBÜ'ye kabulü sırasında demografik verileri, prokalsitonin, C-reaktif protein (CRP) ve laktat seviyeleri kaydedildi. Hastaların hem YBÜ'ye kabulü hem de 24. saatinde NEWS-2 ve mSOFA skorları hesaplandı. NEWS-2 skorunun hesaplanmasında kalp hızı, solunum hızı, sistolik kan basıncı, oksijen satürasyonu, bilinç düzeyi, vücut sıcaklığı ve solunum desteği gibi klinik gözlemler dikkate alındı. Mortalite hesaplamaları alıcı operatör karakteristikleri (ROC) analizleri ile eğri altında kalan alan (AUC) ile gerçekleştirildi. Bulgular Hastaların yaş ortalaması 67,0 ± 17,3 yıldı, hastaların %55'i erkek, %45'i kadındı. Hastaların %85'inde komorbid hastalık izlenmişti. En sık izlenen hastalıklar hipertansiyon (%42,7), diyabetes mellitus (%30,3) ve koroner arter hastalığı (%27,7) idi. Başvuru NEWS-2 skorunun mortalite için AUC değeri 0,757 (%95GA = 0,764-0,845, p<0,001), başvuru mSOFA'nın ise AUC değeri 0,807 (%95GA = 0,764-0,845, p<0,001) idi. Benzer şekilde, 24.saat NEWS-2 skorunun AUC değeri 0,804 (%95GA = 0,759-0,843, p<0,001), 24.saat mSOFA'nın AUC değeri 0,817 (%95GA = 0,774-0,855, p<0,001) idi. Başvuru NEWS-2 skoru 5'in üzerinde olduğunda mortalite için %77,2 sensitivite, %63,1 spesifite gösterirken, 24.saat NEWS-2 skorunun 4'ün üzerinde olması %85,3 sensitivite, %61 spesifite göstermekteydi. Başvuru mSOFA skorunun 4'ün üzerinde olması %59 sensitivite, %84,5 spesifiteye sahipken, 24.saat mSOFA skorunun 3'ün üzerinde olması %66,9 sensitivite, %77,1 spesifiteye sahipti. Hem başvuru hem de 24.saat NEWS-2 skorunun mortalite için AUC değeri prokalsitonin (AUC=0,731), CRP (AUC=0,705) ve laktattan (AUC=0,692) daha yüksekti. Sonuç NEWS-2 skoru acil YBÜ hastalarının prognozları için mSOFA skorlarına benzer bir performans göstermektedir. Rutin vital parametrelerle hesaplanan ve laboratuvar gerektirmeyen NEWS-2 skoru YBÜ hastalarında prognoz tahmini için kullanışlıdır.
Introduction It is important to use scoring systems to predict prognosis in order to improve the outcomes of patients in the intensive care unit (ICU). Besides, future influenza, coronavirus pandemics, outbreaks of influenza,or man-made disasters may overwhelm critical care capacities. Understanding which patients are most likely to benefit from receiving critical care resources may allow for triage of patients in a manner that provides the highest likelihood of survival for the most people. Several scoring systems are currently used to triage of patients and predict mortality in hospitals and ICUs. However, complex mortality prediction models are labor- and resource- intensive and would be difficult to apply. National Early Warning Score-2 (NEWS-2) and modified Sequential Organ Failure Assessment (mSOFA) are almost entirely based on vital parameters used in routine follow-up of patients.Data on the performance of NEWS-2 in predicting prognosis in ICU patients are limited.The aim of this study is to examine the role of NEWS-2, a relatively new scoring system, in the prediction of mortality in emergency ICU patients and to compare NEWS-2 with mSOFA, which is a well-known scoring system. Material and methods In our study, 393 patients admitted to the emergency ICU of a tertiary hospital between 12.2021 and 06.2022 were prospectively included.During admission to ICU, demographics, procalcitonin, C-reactive protein (CRP), and lactate levels were recorded.NEWS-2 and mSOFA were calculated both at ICU admission and at 24 hours.NEWS-2is based on initial clinical observations, including heart rate, respiration rate, systolic blood pressure, oxygen saturation, level of consciousness, body temperature, and respiratory support.Mortality estimation was performed by receiver operating characteristic (ROC) analyses with area under the curve (AUC). Results Patients' mean age was 67.0 ± 17.3 years, 55% were male and 45% were female. Comorbid disease was present in 85% of the patients. The most common diseases werehypertension (42.7%), diabetes mellitus (30.3%) and coronary artery disease (27.7%), respectively. The AUC for admissionNEWS-2 was 0.757, with p<0.001, CI=95% (0.711-0.799), for mSOFA it was 0.807, with p<0.001, CI=95% (0.764-0.845). Similarly, The AUC for 24th NEWS-2 was 0.804, with p<0.001, CI=95% (0.759-0.843), for mSOFA it was 0.817, with p<0.001, CI=95% (0.774-0.855). The admission NEWS-2>5 showed a sensitivity of 77.2% and a specificity of 63.1%, and 24th hours NEWS-2>4 had a sensitivity of 85.3%, and a specificity of 61% to predict mortality. The cutoff point for the admission mSOFA was 4, with 59% sensitivity and 84.5% specificity, and for the 24th mSOFA was 3, with 66.9% sensitivity and 77.1% specificity. Both admission and 24thNEWS-2 had higher AUC than procalcitonin (AUC=0.731), CRP (AUC=0.705), and lactate (AUC=0.692) levels for mortality. Conclusion NEWS-2 score shows similar performance to mSOFA score in predicting prognosis in emergency ICU patients.NEWS-2 scoring, which is calculated with routine vital parameters and does not require laboratory, is useful in prognosis estimation in ICU patients.
Introduction It is important to use scoring systems to predict prognosis in order to improve the outcomes of patients in the intensive care unit (ICU). Besides, future influenza, coronavirus pandemics, outbreaks of influenza,or man-made disasters may overwhelm critical care capacities. Understanding which patients are most likely to benefit from receiving critical care resources may allow for triage of patients in a manner that provides the highest likelihood of survival for the most people. Several scoring systems are currently used to triage of patients and predict mortality in hospitals and ICUs. However, complex mortality prediction models are labor- and resource- intensive and would be difficult to apply. National Early Warning Score-2 (NEWS-2) and modified Sequential Organ Failure Assessment (mSOFA) are almost entirely based on vital parameters used in routine follow-up of patients.Data on the performance of NEWS-2 in predicting prognosis in ICU patients are limited.The aim of this study is to examine the role of NEWS-2, a relatively new scoring system, in the prediction of mortality in emergency ICU patients and to compare NEWS-2 with mSOFA, which is a well-known scoring system. Material and methods In our study, 393 patients admitted to the emergency ICU of a tertiary hospital between 12.2021 and 06.2022 were prospectively included.During admission to ICU, demographics, procalcitonin, C-reactive protein (CRP), and lactate levels were recorded.NEWS-2 and mSOFA were calculated both at ICU admission and at 24 hours.NEWS-2is based on initial clinical observations, including heart rate, respiration rate, systolic blood pressure, oxygen saturation, level of consciousness, body temperature, and respiratory support.Mortality estimation was performed by receiver operating characteristic (ROC) analyses with area under the curve (AUC). Results Patients' mean age was 67.0 ± 17.3 years, 55% were male and 45% were female. Comorbid disease was present in 85% of the patients. The most common diseases werehypertension (42.7%), diabetes mellitus (30.3%) and coronary artery disease (27.7%), respectively. The AUC for admissionNEWS-2 was 0.757, with p<0.001, CI=95% (0.711-0.799), for mSOFA it was 0.807, with p<0.001, CI=95% (0.764-0.845). Similarly, The AUC for 24th NEWS-2 was 0.804, with p<0.001, CI=95% (0.759-0.843), for mSOFA it was 0.817, with p<0.001, CI=95% (0.774-0.855). The admission NEWS-2>5 showed a sensitivity of 77.2% and a specificity of 63.1%, and 24th hours NEWS-2>4 had a sensitivity of 85.3%, and a specificity of 61% to predict mortality. The cutoff point for the admission mSOFA was 4, with 59% sensitivity and 84.5% specificity, and for the 24th mSOFA was 3, with 66.9% sensitivity and 77.1% specificity. Both admission and 24thNEWS-2 had higher AUC than procalcitonin (AUC=0.731), CRP (AUC=0.705), and lactate (AUC=0.692) levels for mortality. Conclusion NEWS-2 score shows similar performance to mSOFA score in predicting prognosis in emergency ICU patients.NEWS-2 scoring, which is calculated with routine vital parameters and does not require laboratory, is useful in prognosis estimation in ICU patients.
Açıklama
Anahtar Kelimeler
Yoğun Bakım Ünitesi, NEWS-2, mSOFA, Prognoz, Mortalite, Intensive Care Unit, NEWS-2, mSOFA, Prognosis, Mortality
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Yalım. M. (2023). Acil yoğun bakım ünitesine kabul edilen hastaların hastane içi mortalite tahmininde news-2 ve msofa skorlarının karşılaştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Acil Tıp Anabilim Dalı, Konya.
