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

Finn Erland Nielsen; Christina Seefeldt Stæhr; Rune Husås Sørensen; Thomas Andersen Schmidt; S M Osama Bin Abdullah

doi:10.2147/IDR.S358544

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

Infect Drug Resist. 2022 Jul 26:15:3967-3979. doi: 10.2147/IDR.S358544. eCollection 2022.

Authors

Finn Erland Nielsen^{1

2}, Christina Seefeldt Stæhr¹, Rune Husås Sørensen², Thomas Andersen Schmidt^{3

4}, S M Osama Bin Abdullah^{2

5}

Affiliations

¹ Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.
² Department of Emergency Medicine, Slagelse Hospital, Slagelse, Denmark.
³ Department of Emergency Medicine, Nordsjaellands Hospital, Hilleroed, Denmark.
⁴ Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
⁵ Department of Internal Medicine, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark.

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.

Keywords: NEWS2; National Early Warning Score 2; infectious disease; new-onset atrial fibrillation; predictive ability; qSOFA; quick sequential organ failure assessment; sepsis.

Grants and funding

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.