Evaluation Of Early-warning Ability Of 28-day Mortality In Critically Ill Patients In Emergency Department By NEWS Score And Emergency Patient's Disease Grading

OBJECTIVE: To investigate the ability of NEWS scores and emergency patient grading for early warning of 28-day mortality in critically ill patients in the emergency department.Methods: The critically ill patients admitted to the First Affiliated Hospital of Hainan Medical University from January 2017 to August 2017 were retrospectively analyzed.Select14 possible influencing factors that may affect the 28-day mortality rate of critically ill patients in the emergency department: gender,age,NEWS,grade of emergency patient,leukocyte,hemoglobin,albumin,prothrombin time,tumor history,history of COPD,history of liver disease,Neurological disease,nephropathy history,and cardiovascular disease history,calculated NEWS scores of the enrolled patients,and evaluated their “emergency patient disease classification”.The above risk factors were subjected to univariate and multivariate regression analysis to determine the 28-day mortality rate of critically ill patients in the emergency department.For independent risk factors,the receiver operating characteristic curve(ROC)and the Hosmer-Lemeshow Test goodness-of-fit test were used to evaluate the ability of independent risk factors to predict 28-day mortality in critically ill patients in the emergency department.Results: A total of 268 patients were included in the current study,181 males and 87 females,aged 16-96 years(57±18).The prognosis was 28 days of follow-up,98 died,and 170 survived.The results of univariate analysis showed that the factors that may affect28-day mortality in critically ill patients were: age,NEWS score,emergency patient classification,blood leukocyte count,plasma albumin,and neurological disease history(p<0.05,OR>1)..Multivariate regression analysis showed that NEWS scores,emergency patient grading,and age were independent influencing factors for 28-day prognosis in critically ill patients(p<0.05,OR>1).The area under the ROC curve(AUC)of NEWS score,emergency patient's disease grade,age,NWES combined age was 0.801,0.614,0.702,and 0.839,respectively.There was statistically significant difference in NEWS scores and AUC scores of emergency patients(Z=3.99 p<0.01).There was no significant difference in NEWS scores and AUC of NWES joint age(z=0.101,p>0.05).There was a significant difference in the AUC of the combined age and the grade of the emergency patient(Z=4.96,p<0.01).The best cut-off point for the NEWS score was7 points,and the age-optimal cut-off point was 65 years.Age combined with the Hosmer-Lemeshow Test goodness-of-fit test between NEWS score and NEWS score and mortality,the goodness of fit of NEWS score(p=0.292)was better than the goodness of fit of age+NEWS score(p=0.135).Conclusions:The NEWS score is superior to the emergency patient's disease grading for early warning of 28-day mortality in critically ill patients in the emergency department.Before and after increasing the age parameter,the NEWS score showed a good degree of calibration after evaluating the prognosis of the subjects.However,the NEWS score had a better fit than the age + NEWS score.