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Published on: January 29, 2011
Respiratory National Early Warning Score for 28-day mortality prediction in suspected sepsis patients in the
Kiattichai Daorattanachai1, Sasimanee Maithong1, Pariwat Phungoen2
1Department of Emergency Medicine, Faculty of Medicine, Thammasat University, 99/209 Phahon Yothin Road, Klong Luang District, Pathum Thani, Pathum Thani Province, 12120, Thailand.
Background:
Most early warning scores were derived in heterogeneous acutely ill populations and are not specifically tailored to patients with suspected sepsis in the emergency department (ED). In sepsis, respiratory rate (RR) is frequently elevated as part of the pathophysiologic response, suggesting that sepsis-focused tools may require recalibrated RR thresholds. We therefore aimed to develop and evaluate the Respiratory National Early Warning Score (R-NEWS), a sepsis-oriented modification emphasizing respiratory parameters, to improve prediction of 28- and 7-day mortality among ED patients with suspected sepsis.
Methods:
We conducted a prospective cohort study in the ED of Thammasat University Hospital, enrolling adults with suspected sepsis and excluding those with cardiac arrest or do-not-resuscitate orders. Multivariable backward stepwise logistic regression identified significant predictors of 28-day mortality, which were then used to construct the R-NEWS scoring system. Predictive performance was evaluated and compared with NEWS, qSOFA, and SIRS using the area under the receiver operating characteristic curve (AuROC).
Results:
A total of 1,348 patients were analyzed; 28-day mortality was 13.4%. Five independent predictors were identified: respiratory rate, need for supplemental oxygen, systolic blood pressure, heart rate, and Glasgow Coma Scale. R-NEWS demonstrated good calibration (Hosmer-Lemeshow p = 0.474) and higher discrimination than NEWS, qSOFA, and SIRS. The AuROC of R-NEWS was 0.72 (95% CI, 0.68, 0.76) for 28-day mortality and 0.76 (95% CI, 0.71, 0.81) for 7-day mortality. Internal validation using bootstrapping yielded consistent results. High-risk R-NEWS (≥ 7) was associated with a 28-day mortality of 28.9%, compared with 3.9% in the low-risk group (≤ 3).
Conclusion:
R-NEWS, a simplified five-parameter score emphasizing respiratory function, demonstrated favorable performance for predicting short- and intermediate-term mortality in ED patients with suspected sepsis. Used alongside clinical judgment, R-NEWS may aid early risk stratification and sepsis management. External, multicenter validation and prospective evaluation are warranted before widespread implementation.
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