National Early Warning Score and New-Onset Atrial Fibrillation for Predicting In-Hospital Mortality or Transfer to the Intensive Care Unit in Emergency Department Patients with Suspected Bacterial Infections

• Published in: Infection and drug resistance Vol. 15; pp. 3967 - 3979
• Main Authors: Nielsen, Finn Erland, Stæhr, Christina Seefeldt, Sørensen, Rune Husås, Schmidt, Thomas Andersen, Abdullah, S M Osama Bin
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 2022; Taylor & Francis Ltd; Dove; Dove Medical Press
• Subjects: Accuracy; Analysis; Antibiotics; Atrial fibrillation; Bacteria; Bacterial infections; Blood pressure; Cardiac arrhythmia; Chronic illnesses; Denmark; Disease; Electrocardiography; Emergency medical care; Emergency service; Fibrillation; Hospital patients; Hospitals; Infection; Infections; infectious disease; Infectious diseases; Intensive care; Laboratories; Medical research; Medicine, Experimental; Mortality; national early warning score 2 (news2); new-onset atrial fibrillation; Original Research; Patient outcomes; Patients; Physiology; predictive ability; Prognosis; quick sequential organ failure assessment (qsofa); Sepsis; United Kingdom; Vital signs; Denmark; United Kingdom; National Early Warning Score 2; predictive ability; NEWS2; quick sequential organ failure assessment; infectious disease; qSOFA; new-onset atrial fibrillation; sepsis
• ISSN: 1178-6973; 1178-6973
• DOI: 10.2147/IDR.S358544

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.
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 (
AUROC) 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.
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.
AUROC 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).
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.