{"title":"增加潮末CO₂和灌注指数NEWS2对30天住院死亡率的预测价值:一项前瞻性研究。","authors":"Ali Sarıdas, Hakan Aydin","doi":"10.1007/s11845-025-04106-z","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate whether integrating end-tidal carbon dioxide (ETCO₂) and perfusion index (PI) into the National Early Warning Score 2 (NEWS2) enhances its ability to predict 30-day in-hospital mortality in patients visitted to the emergency department (ED).</p><p><strong>Methods: </strong>This prospective, single-center cohort study was conducted between March 15 and May 15, 2025, in a tertiary ED. Adult patients requiring continuous monitoring were included. ETCO₂ and PI were measured upon admission and incorporated into the NEWS2 score using predefined thresholds. The primary outcome was 30-day all-cause in-hospital mortality. Model performance was assessed via ROC analysis, Brier score, Hosmer-Lemeshow test, decision curve analysis (DCA), and Net Reclassification Index (NRI).</p><p><strong>Results: </strong>A total of 375 patients were analyzed (mean age: 76.5 ± 7.6 years; 56.8% female), with a 30-day mortality rate of 5.9%. The base NEWS2 had an AUC of 0.804 (95%CI: 0.734-0.868), while the extended NEWS2 + ETCO₂ + PI model demonstrated a significantly higher AUC of 0.893 (95%CI: 0.824-0.944; p < 0.001). The optimal cut-off for the combined model was > 12, yielding 77.3% sensitivity and 90.9% specificity. It also showed superior calibration (Brier score: 0.039; HL p = 0.265) and the highest net clinical benefit between threshold probabilities of 0.22 and 0.45. NRI analysis showed a net reclassification improvement of 46.3%.</p><p><strong>Conclusion: </strong>The integration of ETCO₂ and PI into the NEWS2 score significantly improves its predictive accuracy for short-term mortality. The combined model may contribute to earlier and more accurate identification of high-risk patients in emergency care settings.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Predictive value of adding end-tidal CO₂ and perfusion index to NEWS2 for 30-day in-hospital mortality: a prospective study.\",\"authors\":\"Ali Sarıdas, Hakan Aydin\",\"doi\":\"10.1007/s11845-025-04106-z\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>This study aimed to evaluate whether integrating end-tidal carbon dioxide (ETCO₂) and perfusion index (PI) into the National Early Warning Score 2 (NEWS2) enhances its ability to predict 30-day in-hospital mortality in patients visitted to the emergency department (ED).</p><p><strong>Methods: </strong>This prospective, single-center cohort study was conducted between March 15 and May 15, 2025, in a tertiary ED. Adult patients requiring continuous monitoring were included. ETCO₂ and PI were measured upon admission and incorporated into the NEWS2 score using predefined thresholds. The primary outcome was 30-day all-cause in-hospital mortality. Model performance was assessed via ROC analysis, Brier score, Hosmer-Lemeshow test, decision curve analysis (DCA), and Net Reclassification Index (NRI).</p><p><strong>Results: </strong>A total of 375 patients were analyzed (mean age: 76.5 ± 7.6 years; 56.8% female), with a 30-day mortality rate of 5.9%. The base NEWS2 had an AUC of 0.804 (95%CI: 0.734-0.868), while the extended NEWS2 + ETCO₂ + PI model demonstrated a significantly higher AUC of 0.893 (95%CI: 0.824-0.944; p < 0.001). The optimal cut-off for the combined model was > 12, yielding 77.3% sensitivity and 90.9% specificity. It also showed superior calibration (Brier score: 0.039; HL p = 0.265) and the highest net clinical benefit between threshold probabilities of 0.22 and 0.45. NRI analysis showed a net reclassification improvement of 46.3%.</p><p><strong>Conclusion: </strong>The integration of ETCO₂ and PI into the NEWS2 score significantly improves its predictive accuracy for short-term mortality. 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引用次数: 0
摘要
目的:本研究旨在评估将潮末二氧化碳(ETCO₂)和灌注指数(PI)纳入国家预警评分2 (NEWS2)是否能增强其对急诊患者30天住院死亡率的预测能力。方法:该前瞻性单中心队列研究于2025年3月15日至5月15日在一所高等急诊科进行,纳入了需要持续监测的成年患者。在入院时测量ETCO₂和PI,并使用预定义的阈值将其纳入NEWS2评分。主要终点为30天全因住院死亡率。采用ROC分析、Brier评分、Hosmer-Lemeshow检验、决策曲线分析(DCA)和净重分类指数(NRI)评价模型的性能。结果:共分析375例患者(平均年龄76.5±7.6岁,女性56.8%),30天死亡率为5.9%。基础NEWS2模型的AUC为0.804 (95%CI: 0.734-0.868),扩展NEWS2 + ETCO₂+ PI模型的AUC为0.893 (95%CI: 0.824-0.944; p 12),敏感性为77.3%,特异性为90.9%。它还显示了优越的校准(Brier评分:0.039;HL p = 0.265),阈值概率之间的最高净临床效益为0.22和0.45。NRI分析显示净重分类改善46.3%。结论:将ETCO₂和PI纳入NEWS2评分可显著提高其对短期死亡率的预测准确性。联合模型可能有助于更早和更准确地识别高危患者在紧急护理环境。
Predictive value of adding end-tidal CO₂ and perfusion index to NEWS2 for 30-day in-hospital mortality: a prospective study.
Objective: This study aimed to evaluate whether integrating end-tidal carbon dioxide (ETCO₂) and perfusion index (PI) into the National Early Warning Score 2 (NEWS2) enhances its ability to predict 30-day in-hospital mortality in patients visitted to the emergency department (ED).
Methods: This prospective, single-center cohort study was conducted between March 15 and May 15, 2025, in a tertiary ED. Adult patients requiring continuous monitoring were included. ETCO₂ and PI were measured upon admission and incorporated into the NEWS2 score using predefined thresholds. The primary outcome was 30-day all-cause in-hospital mortality. Model performance was assessed via ROC analysis, Brier score, Hosmer-Lemeshow test, decision curve analysis (DCA), and Net Reclassification Index (NRI).
Results: A total of 375 patients were analyzed (mean age: 76.5 ± 7.6 years; 56.8% female), with a 30-day mortality rate of 5.9%. The base NEWS2 had an AUC of 0.804 (95%CI: 0.734-0.868), while the extended NEWS2 + ETCO₂ + PI model demonstrated a significantly higher AUC of 0.893 (95%CI: 0.824-0.944; p < 0.001). The optimal cut-off for the combined model was > 12, yielding 77.3% sensitivity and 90.9% specificity. It also showed superior calibration (Brier score: 0.039; HL p = 0.265) and the highest net clinical benefit between threshold probabilities of 0.22 and 0.45. NRI analysis showed a net reclassification improvement of 46.3%.
Conclusion: The integration of ETCO₂ and PI into the NEWS2 score significantly improves its predictive accuracy for short-term mortality. The combined model may contribute to earlier and more accurate identification of high-risk patients in emergency care settings.
期刊介绍:
The Irish Journal of Medical Science is the official organ of the Royal Academy of Medicine in Ireland. Established in 1832, this quarterly journal is a contribution to medical science and an ideal forum for the younger medical/scientific professional to enter world literature and an ideal launching platform now, as in the past, for many a young research worker.
The primary role of both the Academy and IJMS is that of providing a forum for the exchange of scientific information and to promote academic discussion, so essential to scientific progress.