A combination of early warning score and lactate to predict intensive care unit transfer of inpatients with severe sepsis/septic shock

Abstract

Background/AimsThe modified early warning score (MEWS) is used to predict patient intensive care unit (ICU) admission and mortality. Lactate (LA) in the blood lactate (BLA) is measured to evaluate disease severity and treatment efficacy in patients with severe sepsis/septic shock. The usefulness of a combination of MEWS and BLA to predict ICU transfer in severe sepsis/septic shock patients is unclear. We evaluated whether use of a combination of MEWS and BLA enhances prediction of ICU transfer and mortality in hospitalized patients with severe sepsis/septic shock.MethodsPatients with severe sepsis/septic shock who were screened or contacted by a medical emergency team between January 2012 and August 2012 were enrolled at a university-affiliated hospital with ~2,700 beds, including 28 medical ICU beds.ResultsOne hundred patients were enrolled and the rate of ICU admittance was 38%. MEWS (7.37 vs. 4.85) and BLA concentration (5 mmol/L vs. 2.19 mmol/L) were significantly higher in patients transferred to ICU than those in patients treated in general wards. The combination of MEWS and BLA was more accurate than MEWS alone in terms of ICU transfer (C-statistics: 0.898 vs. 0.816, p = 0.019). The 28-day mortality rate was 19%. MEWS was the only factor significantly associated with 28-day mortality rate (odds ratio, 1.462; 95% confidence interval, 1.122 to 1.905; p = 0.005).ConclusionsThe combination of MEWS and BLA may enhance prediction of ICU transfer in patients with severe sepsis/septic shock.

Prehospital Point-Of-Care Lactate Increases the Prognostic Accuracy of National Early Warning Score 2 for Early Risk Stratification of Mortality: Results of a Multicenter, Observational Study

“…It is common to find studies that analyze the use of EWS and lactate in people with acute disease [18,19,28] and studies that specifically analyze the association between the NEWS2 and lactate [20,21,29,30]. However, it is rather uncommon to find studies focused on the prehospital context [31][32][33], especially dealing with the use of the pLA for a further evaluation of risk groups stratified by the NEWS2.…”

Development and validation of a mortality risk model for pediatric sepsis

“…[29] Increased levels of the N-terminal prohormone of BNP have been shown to be associated with a dysfunction of the cardiovascular system and systemic inflammation. It was shown that a BNP decline over time implied a favorable outcome and lower mortality risk.…”

New Biomarkers of Sepsis with Clinical Relevance

“…Clinical scores are not effective in early identification of infection in critically ill patients; however, combining these scores with biomarkers allows an early and accurate identification of sepsis. For example, Yoo and co-workers found that combining Modified Early Warning Score (MEWS), a tool for monitoring sepsis, with blood lactate levels was efficient for early identification of the disease [69]. The same was found by Bozza et al [70] and Oberholzer et al [71] when they combined the levels of MPC-1 or IL-6 with APACHE II, respectively, and found greater accuracy in the prognosis of the patients.…”