Data from: Combination of the National Early Warning Score (NEWS) and inflammatory biomarkers for early risk stratification in emergency department patients: results of a multi-national, observational study

Objectives: The National Early Warning Score (NEWS) helps to estimate
mortality risk in emergency department (ED) patients. This study aimed to
investigate whether the prognostic value of the NEWS at ED admission could
be further improved by adding inflammatory blood markers (i.e. white blood
cell count (WBC), procalcitonin (PCT), and MR-ProAdrenomedullin
(MR-proADM). Design: Secondary analysis of a multinational, observational
study. (TRIAGE study, March 2013 to October 2014) Setting: Three tertiary
care centers in France, Switzerland, and the USA. Participants: A total of
1303 adult medical patients with complete NEWS data seeking ED care were
included in the final analysis. NEWS was calculated retrospectively based
on admission data. Main outcome measures: The primary outcome was
all-cause 30-day mortality. Secondary outcome was ICU admission. We used
multivariate regression analyses to investigate associations of NEWS and
blood markers with outcomes and area under the receiver operating curve
(AUC) as a measure of discrimination. Results: Of the 1303 included
patients, 54 (4.1%) died within 30 days. The NEWS alone showed fair
prognostic accuracy for all-cause 30-day mortality (AUC 0.73), with a
multivariate adjusted odds ratio (OR) of 1.26 (95% CI 1.13–1.40,
p<0.001). The AUCs for the prediction of mortality using the
inflammatory markers WBC, PCT, and MR-proADM were 0.64, 0.71, and 0.78,
respectively. Combining NEWS with all three blood markers or only with
MR-proADM clearly improved discrimination with an AUC 0.82 (p= 0.002).
Combining the three inflammatory markers with NEWS improved prediction of
ICU admission (AUC 0.70 vs. 0.65 when using NEWS alone, p=0.006).
Conclusion: NEWS is helpful in risk stratification of ED patients and can
be further improved by the addition inflammatory blood markers. Future
studies should investigate whether risk stratification by NEWS in addition
to biomarkers improve site-of-care decision in this patient population.
Trial registration number: ClinicalTrials.gov; Identifier: NCT01768494