Lactate and NEWS-L are fair predictors of mortality in critically ill geriatric emergency department patients.
Am J Emerg Med 2019;
38:217-221. [PMID:
30770240 DOI:
10.1016/j.ajem.2019.02.006]
[Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/29/2019] [Accepted: 02/07/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION
In this study, we aimed to investigate the prognostic power of the first lactate level measured in the emergency department (ED), National Early Warning Score (NEWS), and NEWS-lactate (NEWS-L) on ED admission in critically ill geriatric patients.
METHODS
This retrospective observational study was conducted in the ED of a university hospital. Consecutive patients ≥65 years of age admitted to our ED between July 1, 2017, and December 31, 2017, and transferred to the intensive care unit after the ED follow-up period were included in the study. The predictive performances of lactate, NEWS, and NEWS-L in terms of in-hospital mortality were compared.
RESULTS
A total of 455 patients were included in the statistical analyses. The in-hospital mortality rate was 22.9%. The mean lactate, NEWS, and NEWS-L of non-survivors was significantly higher than those of survivors (2.9 ± 2.2 vs. 1.9 ± 1.5 mmol/L, 8.9 ± 4.1 vs. 6.1 ± 3.7, and 11.8 ± 5.0 vs. 8.1 ± 4.4, respectively, for all p < 0.001). The AUCs of the lactate, NEWS, and NEWS-L were respectively 0.654 (95% CI 0.594-0.713), 0.686 (95% CI 0.628-0.744), and 0.714 (95% CI 0.658-0.770) in predicting in-hospital mortality.
CONCLUSIONS
According to the results of this study, we conclude that ED admission lactate level and NEWS are low-accuracy predictors of in-hospital mortality in critically ill geriatric patients. Although the combination of lactate level with physiological parameters increases the predictive performances of both parameters, NEWS-L is still not a powerful predictor to make definitive clinical decisions for critically ill geriatric ED patients.
Collapse