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Early warning score: a dynamic marker of severity and prognosis in patients with Gram-negative bacteraemia and sepsis

BACKGROUND: Early Warning Score (EWS) is a physiological composite score of six bedside vital parameters, routinely used in UK hospitals. We evaluated the prognostic ability of EWS in Gram-negative bacteraemia causing sepsis. METHODS: We prospectively evaluated EWS as a marker of severity and progno...

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Autores principales: Albur, Mahableshwar, Hamilton, Fergus, MacGowan, Alasdair P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4830018/
https://www.ncbi.nlm.nih.gov/pubmed/27071911
http://dx.doi.org/10.1186/s12941-016-0139-z
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author Albur, Mahableshwar
Hamilton, Fergus
MacGowan, Alasdair P.
author_facet Albur, Mahableshwar
Hamilton, Fergus
MacGowan, Alasdair P.
author_sort Albur, Mahableshwar
collection PubMed
description BACKGROUND: Early Warning Score (EWS) is a physiological composite score of six bedside vital parameters, routinely used in UK hospitals. We evaluated the prognostic ability of EWS in Gram-negative bacteraemia causing sepsis. METHODS: We prospectively evaluated EWS as a marker of severity and prognosis in adult patients with Gram-negative bacteraemia. All adult patients with Gram-negative bacteraemia admitted to our tertiary Teaching hospital of the National Health Service in England were enrolled over 1 year period. The highest daily EWS score was recorded from 7 days before to 14 days after the date of onset of bacteraemia. The primary outcome was 28-day mortality. MAIN RESULTS: A total of 245 consecutive adult patients with Gram-negative bacteraemia with sepsis were enrolled. On multivariate analysis, following variables were associated with death for every single unit change (odds ratio in the brackets): higher age (1.05), lower mean arterial pressure (1.03), lower serum bicarbonate (1.08), higher EWS (1.27), higher SOFA score (1.36), hospital-onset of infection (5.43) and need for vasopressor agents (16.4). EWS on day 0, 1, 2, and average 14-day score were significantly higher in patients who died by 28 days from the onset of bacteraemia [95 % CI 0.4–0.6] p < 0.001. A stepwise rise in EWS and failure of improvement in EWS by 2 points 48 h after the onset of bacteraemia were associated with poor outcome. CONCLUSION: EWS is a simple and cost-effective bedside tool for the assessment of severity and prognosis of sepsis caused by Gram-negative bacteraemia. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12941-016-0139-z) contains supplementary material, which is available to authorized users.
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spelling pubmed-48300182016-04-14 Early warning score: a dynamic marker of severity and prognosis in patients with Gram-negative bacteraemia and sepsis Albur, Mahableshwar Hamilton, Fergus MacGowan, Alasdair P. Ann Clin Microbiol Antimicrob Research BACKGROUND: Early Warning Score (EWS) is a physiological composite score of six bedside vital parameters, routinely used in UK hospitals. We evaluated the prognostic ability of EWS in Gram-negative bacteraemia causing sepsis. METHODS: We prospectively evaluated EWS as a marker of severity and prognosis in adult patients with Gram-negative bacteraemia. All adult patients with Gram-negative bacteraemia admitted to our tertiary Teaching hospital of the National Health Service in England were enrolled over 1 year period. The highest daily EWS score was recorded from 7 days before to 14 days after the date of onset of bacteraemia. The primary outcome was 28-day mortality. MAIN RESULTS: A total of 245 consecutive adult patients with Gram-negative bacteraemia with sepsis were enrolled. On multivariate analysis, following variables were associated with death for every single unit change (odds ratio in the brackets): higher age (1.05), lower mean arterial pressure (1.03), lower serum bicarbonate (1.08), higher EWS (1.27), higher SOFA score (1.36), hospital-onset of infection (5.43) and need for vasopressor agents (16.4). EWS on day 0, 1, 2, and average 14-day score were significantly higher in patients who died by 28 days from the onset of bacteraemia [95 % CI 0.4–0.6] p < 0.001. A stepwise rise in EWS and failure of improvement in EWS by 2 points 48 h after the onset of bacteraemia were associated with poor outcome. CONCLUSION: EWS is a simple and cost-effective bedside tool for the assessment of severity and prognosis of sepsis caused by Gram-negative bacteraemia. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12941-016-0139-z) contains supplementary material, which is available to authorized users. BioMed Central 2016-04-12 /pmc/articles/PMC4830018/ /pubmed/27071911 http://dx.doi.org/10.1186/s12941-016-0139-z Text en © Albur et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Albur, Mahableshwar
Hamilton, Fergus
MacGowan, Alasdair P.
Early warning score: a dynamic marker of severity and prognosis in patients with Gram-negative bacteraemia and sepsis
title Early warning score: a dynamic marker of severity and prognosis in patients with Gram-negative bacteraemia and sepsis
title_full Early warning score: a dynamic marker of severity and prognosis in patients with Gram-negative bacteraemia and sepsis
title_fullStr Early warning score: a dynamic marker of severity and prognosis in patients with Gram-negative bacteraemia and sepsis
title_full_unstemmed Early warning score: a dynamic marker of severity and prognosis in patients with Gram-negative bacteraemia and sepsis
title_short Early warning score: a dynamic marker of severity and prognosis in patients with Gram-negative bacteraemia and sepsis
title_sort early warning score: a dynamic marker of severity and prognosis in patients with gram-negative bacteraemia and sepsis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4830018/
https://www.ncbi.nlm.nih.gov/pubmed/27071911
http://dx.doi.org/10.1186/s12941-016-0139-z
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