Background: The plethora of available prognostic scores is a barrier for their implementation in acute care settings. In patients with pulmonary embolism (PE), the (simplified) Pulmonary Severity Index ((s)PESI) is a validated score for mortality prediction. The national early warning score (NEWS), a general prognostic risk score for multiple clinical settings, has never been evaluated in PE patients before and may form a useful alternative.
Aims: To evaluate the predictive performance of the NEWS, PESI and sPESI score.
Methods: In a subset of patients from a multicenter prospective cohort study (YEARS study), we evaluated the performance of the NEWS and (s)PESI in hemodynamically stable patients with confirmed PE for predicting 7-day all-cause Intensive Care Unit (ICU) admission, and 30-day all-cause mortality. Receiver operating characteristic (ROC) curves were plotted and the area under the curve (AUC) was calculated.
Results: Of the 352 PE patients, 12 (3.4%) were admitted to the ICU and 5 (1.4%) died. The AUC of the NEWS for ICU admission was 0.80 (95%CI 0.66-0.94), and 0.92 (95%CI 0.82-1.00) for 30-day mortality (Figure 1 & 2). At a threshold of 2 points, NEWS yielded a sensitivity of 93% and 100% for ICU admission and mortality, respectively. The AUC of the PESI was 0.64 (95%CI 0.48-0.79) for ICU admission and 0.94 (95%CI 0.87-1.00)] for mortality (Figure 1 & 2). At a threshold of 66 points, PESI yielded a sensitivity of 75% and 100% for ICU admission and mortality, respectively. The results of the sPESI were similar to those of PESI.
Conclusions: NEWS and (s)PESI both adequately predicted 30-day mortality in patients presenting with acute PE. In contrast to s(PESI), NEWS also adequately discriminate between patients at low and high risk for 7-day ICU admission, underlying its potential relevance for clinical practice. Validation studies are needed to confirm our findings.
To cite this abstract in AMA style:Bavalia R, Stals MAM, FI Mulder , IM Bistervels , M Coppens , LM Faber , SV Hendriks , HMA Hofstee , MV Huisman , T van der Hulle , ATA Mairuhu , MJHA Kruip , S Middeldorp , FA Klok , BA Hutten , F Holleman . Use of the National Early Warning Score for Predicting Deterioration of Patients with Acute Pulmonary Embolism [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/use-of-the-national-early-warning-score-for-predicting-deterioration-of-patients-with-acute-pulmonary-embolism/. Accessed December 3, 2021.
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