Predictive Performance of the NEWS‒Lactate and NEWS Towards Mortality or Need for Critical Care Among Patients with Suspicion of Sepsis in the Emergency Department: A Prospective Observational Study

Ar-aishah Dadeh, Matina Kulparat Department of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, ThailandCorrespondence: Ar-aishah Dadeh, Department of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand, Tel +6674-451705, Fax +6674-451704, Email dadehstou@gmail.comObjective: We aimed to evaluate the National Early Warning Score‒Lactate (NEWS‒L) and NEWS to predict 24-hour mortality as the primary outcome. The secondary outcomes were to predict 48-hour, 28-day, and in-hospital mortality rates, and the need for critical care in patient with suspicion of sepsis at the emergency department (ED).Methods: A prospective observational study was performed in patients aged ≥ 18 years diagnosed with sepsis in the ED from March to November 2021. Area under the receiver operating characteristic curve (AUROC) analyses determined the predictive values of NEWS and NEWS‒L for 24-hour mortality.Results: Ninety-two patients were enrolled (mean age 68 years, 48 [52.2%] males). Three (3.2%) patients died within 24 hours and 34 (36.9%) patients needed critical care during the ED stay. The median (interquartile range) NEWS and NEWS-L results were higher in the 24-hour non-survivors versus survivors: 12 (10.5, 12.5) versus 8 (6, 9) (p = 0.024) and 18.7 (15.2, 19.1) versus 10.6 (8.9, 13) (p = 0.036), respectively. The adjusted odds ratio (aOR) was 1.22 for the primary outcome as the NEWS-L increased by 1 unit without statistical significance (p = 0.228). The aOR values for the secondary outcomes ranged from 1.34 to 1.67 with statistical significance. A NEWS-L of 11 and a NEWS of 12 predicted 24-hour mortality with sensitivities/specificities of 100%/56% and 67%/91%, respectively. The AUROC values of NEWS-L for mortality at 24 hours, 48 hours, 28 days, and in-hospital patients, and the need for critical care were 0.860, 0.905, 0.813, 0.839, and 0.837, respectively.Conclusion: NEWS-L is an accurate predictor for 24-hour mortality in septic patients in the ED. NEWS‒L performed better than NEWS for each outcome. NEWS‒L demonstrated good to excellent performance and was accurate in predicting sepsis related to adverse outcomes.Keywords: National Early Warning Score, NEWS, NEWS-lactate, sepsis, mortality, need for critical care