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
Abstract
:1. Introduction
2. Material and Methods
2.1. Study Design
2.2. Study Setting
2.3. Population
2.4. Study Protocol
2.5. Data Abstraction
2.6. Data Analysis
3. Results
3.1. Patients
3.2. Patient Classification and Global NEWS2 Performance
3.3. Comparison of Mortality Discrimination Derived from pLA and NEWS2
4. Discussion
Strength and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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NEWS2 | 3 | 2 | 1 | 0 | 1 | 2 | 3 |
---|---|---|---|---|---|---|---|
Pulse (bpm) | ≤40 | 41–50 | 51–90 | 91–110 | 111–130 | ≥131 | |
BR (bpm) | ≤8 | 9–11 | 12–20 | 21–24 | ≥25 | ||
T (°C) | ≤35 | 35.1–36 | 36.1–38 | 38.1–39 | ≥39.1 | ||
SBP (mmHg) | ≤90 | 91–100 | 101–110 | 111–219 | ≥220 | ||
SpO2 (%) Scale 1 | ≤91 | 92–93 | 94–95 | ≥96 | |||
SpO2 (%) Scale 2 1 | ≤83 | 84–85 | 86–87 | 88–92 ≥93 air | 93–94 Oxygen | 95–96 Oxygen | ≥97 Oxygen |
Air oxygen | Oxygen | Air | |||||
AVPU (scale) | A | V, P, U |
Characteristic 1 | Total | Survivors | Non-Survivors | p-Value |
---|---|---|---|---|
Number (n (%)) | 3081 (100) | 2944 (95.6) | 137 (4.4) | |
Age (years) | 69 (54–81) | 69 (53–81) | 80 (65–87) | 0.001 2 |
Female | 1269 (41.2) | 1218 (41.4) | 51 (37.2) | 0.335 3 |
Isochronous (Minutes) | ||||
Arrival time | 10 (8–13) | 10 (8–13) | 10 (8–15) | 0.184 2 |
Support time | 28 (22–34) | 28 (22–34) | 32 (25–39) | 0.001 2 |
Transfer time | 10 (7–14) | 10 (7–13) | 10 (7–18) | 0.039 2 |
Initial Evaluation | ||||
NEWS 2 (points) | 4 (2–7) | 4 (2–6) | 11 (7–13) | 0.001 2 |
Breathing rate (bpm) | 17 (14–24) | 17 (14–22) | 23 (14–34) | 0.001 2 |
Supplemental oxygen | 389 (12.6) | 343 (11.7) | 46 (33.6) | 0.001 2 |
Oxygen saturation (%) | 96 (93–98) | 96 (93–98) | 83 (72–93) | 0.001 2 |
Heart rate (bpm) | 85 (70–104) | 84 (70–102) | 97 (71–121) | 0.009 2 |
SBP (mmHg) | 137 (118–155) | 137 (119–155) | 124 (93–153) | 0.002 2 |
Temperature (°C) | 36.3 (36.0–36.8) | 36.3 (36.0–36.8) | 36.0 (35.1–37.0) | 0.014 2 |
GCS (3–15 points) | 15 (15–15) | 15 (15–15) | 11 (3–15) | 0.001 2 |
pLA (mmol/L) | 2.9 (2.0–4.0) | 2.8 (1.9–3.8) | 5.1 (4.3–7.3) | 0.001 2 |
Hospital Outcomes | ||||
Inpatients | 1718 (55.8) | 1581 (53.7) | 137 (100) | 0.001 2 |
ICU | 526 (17.1) | 455 (15.5) | 71 (51.8) | 0.001 2 |
Pathologies | Total | Survivors | Non-Survivors |
---|---|---|---|
Abdominal Pain/Problems | 176 (5.7) | 166 (5.6) | 10 (7.3) |
Allergies (Reactions) | 33 (1.1) | 33 (1.1) | 0 |
Animal Bites/Attacks | 3 (0.1) | 3 (0.1) | 0 |
Assault/Sexual Assault/Stun Gun | 2 (0.1) | 1 (0) | 1 (0.7) |
Breathing Problems | 333 (10.8) | 311 (10.6) | 22 (16.1) |
Burns (Scalds)/Explosions | 7 (0.2) | 6 (0.2) | 1 (0.7) |
Carbon Monoxide/Inhalation | 12 (0.4) | 12 (0.4) | 0 |
Chest Pain | 593 (19.2) | 579 (19.7) | 14 (10.2) |
Choking | 17 (0.6) | 12 (0.4) | 5 (3.6) |
Convulsions/Seizures | 185 (6.0) | 185 (6.3) | 0 |
Diabetic Problems | 37 (1.2) | 36 (1.2) | 1 (0.7) |
Electrocution/Lightning | 2 (0.1) | 2 (0.1) | 0 |
Falls | 59 (1.9) | 57 (1.9) | 2 (1.5) |
Headache | 64 (2.1) | 64 (2.2) | 0 |
Heart Problems/AICD | 381 (12.4) | 349 (11.9) | 32 (23.4) |
Heat/Cold Exposure | 11 (0.4) | 10 (0.3) | 1 (0.7) |
Hemorrhage/Lacerations | 27 (0.9) | 27 (0.9) | 0 |
Inaccessible Incident/Entrapments | 3 (0.1) | 3 (0.1) | 0 |
Overdose/Poisoning (Ingestion) | 158 (5.1) | 154 (5.2) | 4 (2.9) |
Sick Person | 106 (3.4) | 96 (3.3) | 10 (7.3) |
Stab/Gunshot/Penetrating Trauma | 10 (0.3) | 10 (0.3) | 0 |
Stroke/Transient Ischemic Attack | 301 (9.8) | 290 (9.9) | 11 (8.0) |
Traffic/Transportation Incidents | 160 (5.2) | 155 (5.3) | 5 (3.6) |
Traumatic Injuries | 49 (1.6) | 44 (1.5) | 5 (3.6) |
Unconscious/Fainting (Near) | 352 (11.4) | 339 (11.5) | 13 (9.5) |
Variable | Mortality Risk | |||
---|---|---|---|---|
Low | Low-Medium | Medium | High | |
Number | 1656 (53.8) | 139 (4.5) | 483 (15.7) | 803 (26.1) |
Age (years) | 65 (51–78) | 66 (49–79) | 72 (55–83) | 76 (62–84) |
Female | 669 (52.7) | 67 (5.2) | 208 (16.4) | 325 (25.6) |
pLA (mmol/L) | 2.4 (1.8–3.4) | 2.9 (2.0–3.8) | 3.1 (2.2–4.4) | 3.7 (2.6–5.1) |
Hospital Outcomes | ||||
Inpatients | 741 (44.7) | 57 (41) | 290 (60.0) | 630 (78.5) |
ICU | 223 (13.4) | 21 (15.1) | 76 (15.7) | 206 (25.7) |
Mortality | 8 (0.5) | 1 (0.7) | 23 (4.8) | 105 (13.1) |
Mortality Risk by pLA | ||||
Low | Low-Medium | Medium | High | |
Prev. | 0.005 | 0.005 | 0.048 | 0.131 |
pLA cut-off | 4.0 | 4.9 | 4.3 | 4.1 |
Se | 28.3 (8.83–47.7) | 50 (12.2–87.7) | 30.4 (11.7–49.1) | 28.4 (11.5–45.4) |
Sp | 86.4 (73.1–99.6) | 71.2 (45.1–97.3) | 81.5 (67.3–95.6) | 81.0 (67.4–94.6) |
PPV | 1.01 (0.37–1.65) | 1.35 (0–3.08) | 7.46 (5.25–9.67) | 15.2 (10.6–19.7) |
NPV | 99.6 (99.5–99.7) | 99.5 (99.2–99.8) | 96.2 (95.4–97.1) | 89.4 (87.4–91.3) |
LR+ | 2.14 (0.78–3.51) | 1.97 (0–4.55) | 1.66 (1.15–2.17) | 1.29 (0.87–1.7) |
LR− | 0.77 (0.58–0.95) | 0.57 (0.15–1) | 0.77 (0.59–0.95 | 0.80 (0.63–0.95 |
DA | 86.1 (73–99.2) | 71.1 (45.3–96.8) | 79.1 (66.4–91.7) | 74,1 (64.3–83.9) |
OR | 1.27 (1.12–1.45) (p < 0.001) | NS | 1.15 (1.06–1.24) (p < 0.001) | 1.15 (1.10–120) (p < 0.001) |
Mortality Risk by NEWS 2 | ||||
Low | Low-Medium | Medium | High | |
Prev. | 0.005 | NA | 0.048 | 0.131 |
NEWS2 cut-off | 2 | NA | 5 | 11 |
Se | 65 (21.9–100) | NA | 69.5 (0–100) | 66.7 (57.2–75) |
Sp | 40.8 (0–81.9) | NA | 27 (0–100) | 74.6 (71.3–77.7) |
PPV | 0.52 (0.30–0.74) | NA | 4.5 (1.22–7.78) | 28.3 (23.1–34.3) |
NPV | 99.6 (99.4–99.8) | NA | 94.8 (NA–NA) | 93.7 (91.4–95.4) |
LR+ | 1.09 (0.63–1.54) | NA | 0.94 (0.22–1.66) | 2.63 (2.18–3.17) |
LR− | 0.81 (0.44–1.19) | NA | 1.08 (NA–NA) | 0.45 (0.34–0.59) |
DA | 40.9 (18.9–81.6) | NA | 26.9 (0–100) | 73.6 (70.4–76.5) |
OR | NS | NS | NS | 5.89 (3.79–9.14) (p < 0.001) |
Survivors | Non-Survivors | Odd Ratios | ||
---|---|---|---|---|
NEWS2 < 3 | pLA < 4 | 944 (100%) | 0 (0%) | * |
pLA > 4 | 158 (97.5%) | 4 (2.5%) | ||
NEWS2 > 3 | pLA < 4 | 1075 (98.5%) | 17 (1.5%) | 15.75(9.27–28.32) p < 0.001 |
pLA > 4 | 449 (80%) | 112 (20%) |
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Share and Cite
Martín-Rodríguez, F.; López-Izquierdo, R.; Delgado Benito, J.F.; Sanz-García, A.; del Pozo Vegas, C.; Castro Villamor, M.Á.; Martín-Conty, J.L.; Ortega, G.J. 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. J. Clin. Med. 2020, 9, 1156. https://doi.org/10.3390/jcm9041156
Martín-Rodríguez F, López-Izquierdo R, Delgado Benito JF, Sanz-García A, del Pozo Vegas C, Castro Villamor MÁ, Martín-Conty JL, Ortega GJ. 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. Journal of Clinical Medicine. 2020; 9(4):1156. https://doi.org/10.3390/jcm9041156
Chicago/Turabian StyleMartín-Rodríguez, Francisco, Raúl López-Izquierdo, Juan F. Delgado Benito, Ancor Sanz-García, Carlos del Pozo Vegas, Miguel Ángel Castro Villamor, José Luis Martín-Conty, and Guillermo J. Ortega. 2020. "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" Journal of Clinical Medicine 9, no. 4: 1156. https://doi.org/10.3390/jcm9041156