Abstract
Purpose: There are conflicting data regarding the role of the National Early Warning Score 2 (NEWS2) in predicting adverse outcomes in patients with infectious diseases. New-onset atrial fibrillation (NO-AF) has been suggested as a sepsis-defining sign of organ dysfunction. This study aimed to examine the prognostic accuracy of NEWS2 and whether NO-AF can provide prognostic information in emergency department (ED) patients with suspected bacterial infections. Patients and Methods: Secondary analyses of data from a prospective observational cohort study of adults admitted in a 6-month period with suspected bacterial infections. We used the composite endpoint of in-hospital mortality or transfer to the intensive care unit as the primary outcome. The prognostic accuracy of NEWS2 and quick sequential organ failure assessment (qSOFA) and covariate-adjusted area under the receiver operating curves (AAUROC) were used to describe the performance of the scores. Logistic regression analysis was used to examine the association between NO-AF and the composite endpoint. Results: A total of 2055 patients were included in this study. The composite endpoint was achieved in 198 (9.6%) patients. NO-AF was observed in 80 (3.9%) patients. The sensitivity and specificity for NEWS2 ≥5 were 70.2% (63.3–76.5) and 60.2% (57.9–62.4), respectively, and those for qSOFA ≥2 were 26.3% (20.3–33.0) and 91.0% (89.6–92.3), respectively. AAUROC for NEWS2 and qSOFA were 0.68 (0.65–0.73) and 0.63 (0.59–0.68), respectively. The adjusted odds ratio for achieving the composite endpoint in 48 patients with NO-AF who fulfilled the NEWS2 ≥5 criteria was 2.71 (1.35–5.44). Conclusion: NEWS2 had higher sensitivity but lower specificity and better, albeit poor, discriminative ability to predict the composite endpoint compared to qSOFA. NO-AF can provide important prognostic information.
Original language | English |
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Journal | Infection and Drug Resistance |
Volume | 15 |
Pages (from-to) | 3967-3979 |
ISSN | 1178-6973 |
DOIs | |
Publication status | Published - 2022 |
Bibliographical note
Funding Information:This project received financial support from the Region Zealand Health Research Foundation, Naestved, Slagelse and Ringsted Hospitals Research Fund, and the Department of Emergency Medicine, Bispebjerg and Frederiksberg Hospital, Denmark.
Keywords
- infectious disease
- National Early Warning Score 2
- new-onset atrial fibrillation
- NEWS2
- predictive ability
- qSOFA
- quick sequential organ failure assessment
- sepsis