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Lactate improves the predictive ability of the National Early Warning Score 2 in the emergency department

  • Author Footnotes
    i Drs. Durantez-Fernández and Polonio-López are joint first authors.
    Carlos Durantez-Fernández
    Footnotes
    i Drs. Durantez-Fernández and Polonio-López are joint first authors.
    Affiliations
    Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain

    Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla La Mancha, Talavera de la Reina, Spain
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  • José L. Martín-Conty
    Correspondence
    Corresponding author at: Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, Universidad de Castilla-La Mancha, Av. Real Fábrica de Sedas, S/N, Talavera de la Reina, Toledo, 45600, Spain. Tel.: +34 680795928.
    Affiliations
    Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain

    Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla La Mancha, Talavera de la Reina, Spain
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  • Author Footnotes
    i Drs. Durantez-Fernández and Polonio-López are joint first authors.
    Begoña Polonio-López
    Footnotes
    i Drs. Durantez-Fernández and Polonio-López are joint first authors.
    Affiliations
    Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain

    Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla La Mancha, Talavera de la Reina, Spain
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  • Miguel Ángel Castro Villamor
    Affiliations
    Advanced Clinical Simulation Centre, Faculty of Medicine, University of Valladolid, Valladolid, Spain
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  • Clara Maestre-Miquel
    Affiliations
    Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
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  • Antonio Viñuela
    Affiliations
    Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain

    Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla La Mancha, Talavera de la Reina, Spain
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  • Raúl López-Izquierdo
    Affiliations
    Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
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  • Laura Mordillo-Mateos
    Affiliations
    Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain

    Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla La Mancha, Talavera de la Reina, Spain
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  • Felipe Fernández Méndez
    Affiliations
    University School of Nursing, University of Vigo, Pontevedra, Spain
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  • Cristina Jorge Soto
    Affiliations
    Faculty of Nursing, University of Santiago de Compostela, Santiago de Compostela, Spain

    CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain
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  • Francisco Martín-Rodríguez
    Affiliations
    Advanced Clinical Simulation Centre, Faculty of Medicine, University of Valladolid, Valladolid, Spain

    Advanced life support. Gerencia de Emergencias Sanitarias. Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
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  • Author Footnotes
    i Drs. Durantez-Fernández and Polonio-López are joint first authors.
Published:November 30, 2021DOI:https://doi.org/10.1016/j.aucc.2021.10.007

      Abstract

      Aims

      The aim of this study was to compare the ability to predict 2-, 7-, 14-, and 30-day in-hospital mortality of lactate vs the National Early Warning Score 2 (NEWS2) vs the arithmetic sum of the NEWS2 plus the numerical value of lactate (NEWS2-L).

      Methods

      This was a prospective, multicentric, emergency department delivery, pragmatic cohort study. To determine the predictive capacity of lactate, we calculated the NEWS2 and NEWS2-L in adult patients (aged >18 years) transferred with high priority by ambulance to the emergency department in five hospitals of Castilla y Leon (Spain) between November 1, 2019, and September 30, 2020. The area under the receiver operating characteristic curve of each of the scales was calculated in terms of mortality for every time frame (2, 7, 14, and 30 days). We determined the cut-off point of each scale that offered highest sensitivity and specificity using the Youden index.

      Results

      A total of 1716 participants were included, and the in-hospital mortality rates at 2, 7, 14, and 30 days were of 7.8% (134 cases), 11.6% (200 cases), 14.2% (243 cases), and 17.2% (295 cases), respectively. The best cut-off point determined in the NEWS2 was 6.5 points (sensitivity of 97% and specificity of 59%), and for lactate, the cut-off point was 3.3 mmol/L (sensitivity of 79% and specificity of 72%). Finally, the combined NEWS2-L showed a cut-off point of 11.7 (sensitivity of 86% and a specificity of 85%). The area under the receiver operating characteristic curve of the NEWS2, lactate, and NEWS2-L in the validation cohort for 2-day mortality was 0.889, 0.856, and 0.923, respectively (p<0.001 in all cases).

      Conclusions

      The new score generated, NEWS2-L, obtained better statistical results than its components (NEWS2 and lactate) separately.

      Keywords

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