Valor pronóstico de la escala National Early Warning Score 2 (NEWS-2) en la atención urgente de pacientes mayores de 80 años con infección: estudio observacional

Abstract

Introduction

Prognostic stratification of very elderly patients with infection presenting to the emergency department remains challenging. The National Early Warning Score 2 (NEWS-2) is widely used to identify the risk of clinical deterioration; however, its prognostic performance in patients aged 80 years or older has been insufficiently evaluated.

Objective

To assess the prognostic value of NEWS-2 for in-hospital mortality in patients aged ≥ 80 years presenting to the emergency department with infection who receive antibiotic therapy and require hospital admission.

Methods

We conducted a retrospective observational study in an emergency department during 2022. Patients aged ≥ 80 years with infection, initiation of antibiotic therapy in the emergency department, and subsequent hospital admission were included. Collected variables comprised comorbidity (Charlson Comorbidity Index), functional status (Barthel Index), frailty (Clinical Frailty Scale), and NEWS-2 at admission. The primary outcome was in-hospital mortality. Multivariate logistic regression analysis and assessment of discriminatory performance were performed.

Results

A total of 987 patients were included (mean age 87 years; 53% women). In-hospital mortality was 13%. NEWS-2 was independently associated with mortality (OR: 1.30; 95% CI: 1.22-1.37). The area under the receiver operating characteristic curve was 0.748 (95% CI: 0.698-0.797). A NEWS-2 cut-off value of ≥ 8 showed a sensitivity of 54% and a specificity of 85%, with adequate model calibration.

Conclusions

NEWS-2 demonstrates moderate prognostic accuracy for in-hospital mortality in patients aged ≥ 80 years with infection attended in the emergency department who require hospital admission, and may provide complementary information to support clinical decision-making in this population.