ABSTRACT
Objective To investigate the prognostic value of National Early Warning Scores (NEWS) combined with arterial lactate level in elderly patients with critical illness in emergency department.Methods A total of 413 elderly patients with critical illness randomly (random number) selected from resuscitation room in emergency department from September 2013 to July 2015 were enrolled in this study.NEWS system was employed to determine the patients' condition.Arterial lactate level was detected.The patients were followed for the 30-day death by telephone calls and patients were divided into survival group and death group.Multivariate logistic regression analysis and receiver operating characteristic curve (ROC) were used to evaluate the prognostic values of NEWS score,arterial lactate level,and NEWS score combined with arterial lactate level in patients without survival.Results There were significant differences in NEWS score and arterial lactate level between the death group and the survival group.The results of multiple factor regression showed that NEWS score,arterial lactate level,and NEWS score combined with arterial lactate level were all independent predictors of 30-day death (P ＜ 0.05,OR ＞ 1).The AUCs of the three evaluation modalities were 0.721,0.746 and 0.762,respectively.There was a significant difference in the area under the ROC curve between NEWS score and NEWS score combined with arterial lactate level.The optimal cut-off point of NEWS score was 7,and arterial lactate level was 2.7 mmol/L.Conclusions NEWS score,arterial lactate level,and NEWS score combined with arterial lactate level were independent predictors of 30-day death in elderly patients with critical illness in emergency department.They all had some predictive value,and NEWS score combined with arterial lactate level had higher capability to predict 30-day death in elderly patients with critical illness in emergency department than NEWS score alone.
ABSTRACT
BACKGROUND: Systemic inflammatory reaction syndrome (SIRS) describes the systemic inflammatory process and can be seen following a wide variety of insults. This is the leading cause of morbidity and mortality for patients admitted to the ICU. The arterial keton body ratio (AKBR), serum lactate level and the thyroid hormones, thyroid stimulation hormone (TSH), thyroxine (T4), free thyroxine (FT4) and triiodothyronine (T3) deteriorate in critically ill patients with a poor prognosis. The APACHE (Acute Physiology, and Chronic Health Evaluation) III and multiple organ failure (MOF) score have been known as good prognostic predictors in the ICU. The object of this study was to compare the AKBR, lactate and thyroid hormone levels, and the APACHE III and MOF score between the survivors (SV) and nonsurvivors (NSV) and the correlation among the above predictors. METHODS: 35 patients with no known thyroid or liver disease who were admitted to the SICU with the criteria of SIRS were selected. Arterial blood was drawn for the AKBR, and the lactate and thyroid hormones studies. The APACHE III and MOF scorings were done in the first 24 hours of SICU admission. RESULTS: There were no significant difference between SV and NSV except APACHE III (SV: 68.7 24.6, NSV; 92.9 27.6). There were significant correlations between the APACHE III and MOF score (R = 0.688, P<0.01), APACHE III and lactate (R = 0.575, P<0.01), and MOF score and lactate (R =0.483, P<0.01). Thyroid hormones had positive correlations among themselves only. CONCLUSIONS: We conclude that APACHE III is the only good predictor of mortality. The APACHE III, MOF score, and lactate level show good correlations indicating the severity in condition of the ICU patients.