Predictive Ability of the National Early Warning Score in Mortality Prediction of Acute Pulmonary Embolism in the Southeast Asian Population
Abstract
:1. Introduction
2. Materials and Methods
Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | All Patients (n = 696) | Non-Survivors (n = 133) | Survivors (n = 563) | p Value |
---|---|---|---|---|
Age (years) | 57.7 ± 15.7 | 59.2 ± 14.3 | 57.4 ± 15.9 | 0.228 |
Male, n (%) | 286 (41.1) | 67 (50.4) | 219 (38.9) | 0.019 |
Comorbidities | ||||
Hypertension | 305 (43.8) | 54 (40.6) | 251 (44.6) | 0.438 |
Diabetes mellitus | 114 (16.4) | 23 (17.3) | 91 (16.2) | 0.419 |
Heart failure | 42 (6.0) | 8 (6.0) | 34 (6.0) | 1.000 |
COPD | 38 (5.5) | 11 (8.3) | 27 (4.8) | 0.135 |
Cirrhosis | 31 (4.5) | 10 (7.5) | 21 (3.7) | 0.064 |
Obesity | 12 (1.7) | 2 (1.5) | 10 (1.8) | 1.000 |
Risk factors | ||||
Active malignancy | 383 (55.0) | 100 (75.2) | 283 (50.4) | <0.001 |
Surgery (<4 weeks) | 141 (20.3) | 21 (15.8) | 120 (21.4) | 0.187 |
Immobilization | 211 (30.4) | 50 (37.6) | 161 (28.6) | 0.047 |
Long travel | 10 (1.4) | 1 (0.8) | 9 (1.6) | 0.696 |
Unprovoked (idiopathic) PE | 136 (19.5) | 13 (9.8) | 123 (21.8) | 0.004 |
Active DVT | 245 (35.2) | 51 (38.3) | 194 (34.5) | 0.674 |
Symptoms and signs | ||||
Asymptomatic (incidental) PE | 228 (32.8) | 29 (21.8) | 199 (35.4) | 0.003 |
Dyspnea | 453 (65.1) | 109 (82.0) | 344 (61.3) | <0.001 |
Chest pain | 112 (16.1) | 14 (10.5) | 98 (17.5) | 0.018 |
Syncope | 54 (7.8) | 14 (10.5) | 40 (7.1) | 0.207 |
Heart rate (bpm) | 105.4 ± 18.4 | 112.5 ± 17.7 | 103.6 ± 18.1 | <0.001 |
Tachycardia (HR ≥ 110/min) | 326 (46.8) | 89 (66.9) | 237 (42.2) | <0.001 |
Respiratory rate (bpm) | 24.3 ± 6.1 | 26.7 ± 6.6 | 23.7 ± 65.9 | <0.001 |
Tachypnea (RR ≥ 30/min) | 158 (22.7) | 51 (38.3) | 107 (19.0) | <0.001 |
SBP (mmHg), mean ± SD | 116.4 ± 21.9 | 110.4 ± 22.2 | 117.8 ± 21.7 | 0.001 |
DBP (mmHg), mean ± SD | 72.3 ± 13.9 | 68.9 ± 14.3 | 73.1 ± 13.7 | 0.002 |
MAP (mmHg), mean ± SD | 87.0 ± 15.7 | 82.8 ± 16.2 | 88.0 ± 15.4 | 0.001 |
SpO2 (%) | 89.4 ± 7.9 | 86.9 ± 7.4 | 89.9 ± 8.0 | <0.001 |
Desaturation (SpO2 < 90%) | 333 (47.8) | 89 (67.4) | 244 (43.8) | <0.001 |
Acute respiratory failure * | 129 (18.5) | 48 (36.1) | 81 (14.4) | <0.001 |
Electrocardiogram | ||||
Sinus tachycardia | 393 (56.5) | 101 (75.9) | 292 (51.9) | <0.001 |
S1Q3T3 | 160 (23.0) | 35 (26.3) | 125 (22.2) | 0.470 |
RV strain pattern | 112 (16.1) | 21 (15.8) | 91 (16.2) | 0.728 |
Echocardiography | ||||
RV dysfunction (n = 332) | 132 (39.8) | 26 (42.6) | 106 (39.1) | 0.665 |
CT imaging | ||||
RV/LV > 1 | 190 (27.3) | 43 (32.3) | 147 (26.1) | 0.160 |
Mediastinal (central) emboli | 310 (44.5) | 51 (38.3) | 259 (46.0) | 0.121 |
Biomarkers | ||||
Troponin-T, pg/mL (median, IQR) (N = 228) | 53.1 (19.6, 159.5) | 122.0 (34.0, 233.3) | 40.2 (16.0, 114.5) | 0.002 |
D-dimer, ng/mL (median, IQR) (N = 129) | 8850.0 (4242.5, 18,748.5) | 12,820.0 (7058.0, 32,909.0) | 7316.0 (3898.0, 14,389.0) | 0.024 |
Predictive scores | ||||
NEWS2 (median, IQR) | 8.0 (3.0, 10.0) | 10.0 (7.0, 11.0) | 7.0 (2.0, 9.0) | <0.001 |
PESI score (median, IQR) | 106.0 (88.0, 129.0) | 133.0 (107.0, 153.0) | 101.0 (85.0, 121.0) | <0.001 |
NEWS Cut-Off | Sensitivity (%) (95% CI) | Specificity (%) (95% CI) | LR+ (95% CI) | LR− (95% CI) | AUROC (95% CI) |
---|---|---|---|---|---|
≥5.0 | 82.0 (74.4, 88.1) | 35.3 (31.4, 39.5) | 1.27 (1.15, 1.40) | 0.51 (0.35, 0.75) | 0.59 (0.55, 0.63) |
≥6.0 | 81.2 (73.5, 87.5) | 40.0 (35.9, 44.1) | 1.35 (1.22, 1.50) | 0.47 (0.33, 0.69) | 0.61 (0.57, 0.65) |
≥7.0 | 77.4 (69.4, 84.2) | 47.6 (43.4, 51.8) | 1.48 (1.31, 1.67) | 0.47 (0.34, 0.66) | 0.63 (0.58, 0.67) |
≥8.0 | 71.4 (63.0, 78.9) | 54.7 (50.5, 58.9) | 1.58 (1.37, 1.82) | 0.52 (0.39, 0.69) | 0.63 (0.59, 0.67) |
≥9.0 | 66.9 (58.2, 74.8) | 66.3 (62.2, 70.2) | 1.98 (1.68, 2.34) | 0.50 (0.39, 0.64) | 0.67 (0.62, 0.71) |
≥10.0 | 50.4 (41.6, 59.2) | 77.4 (73.8, 80.9) | 2.23 (1.78, 2.80) | 0.64 (0.54, 0.77) | 0.64 (0.59, 0.69) |
≥11.0 | 34.6 (26.6, 43.3) | 86.3 (83.2, 89.1) | 2.53 (1.85, 3.46) | 0.76 (0.67, 0.86) | 0.61 (0.56, 0.65) |
≥12.0 | 21.8 (15.1, 29.8) | 92.5 (90.0, 94.6) | 2.92 (1.89, 4.51) | 0.85 (0.77, 0.93) | 0.57 (0.54, 0.61) |
≥13.0 | 14.3 (8.8, 21.4) | 94.8 (92.7, 96.5) | 2.77 (1.61, 4.79) | 0.90 (0.84, 0.97) | 0.55 (0.51, 0.58) |
NEWS Cut-Off | Sensitivity (%) (95% CI) | Specificity (%) (95% CI) | LR+ (95% CI) | LR− (95% CI) | AUROC (95% CI) |
---|---|---|---|---|---|
≥5.0 | 97.4 (86.5, 99.9) | 33.8 (30.2, 37.5) | 1.47 (1.37, 1.59) | 0.08 (0.01, 0.53) | 0.66 (0.63, 0.69) |
≥6.0 | 97.4 (86.5, 99.9) | 37.9(34.2, 41.7) | 1.57 (1.45, 1.70) | 0.07 (0.01, 0.47) | 0.68 (0.65, 0.71) |
≥7.0 | 97.4 (86.5, 99.9) | 45.2 (41.4, 49.1) | 1.78 (1.63, 1.94) | 0.06 (0.01, 0.39) | 0.71 (0.68, 0.75) |
≥8.0 | 97.4 (86.5, 99.9) | 52.5 (48.6, 56.4) | 2.05 (1.87, 2.26) | 0.05 (0.01, 0.34) | 0.75 (0.72, 0.78) |
≥9.0 | 89.7 (75.8, 97.1) | 62.9 (59.0, 66.6) | 2.42 (2.09, 2.79) | 0.16 (0.06, 0.41) | 0.76 (0.71, 0.82) |
≥10.0 | 79.5 (63.5, 90.7) | 75.2 (71.7, 78.4) | 3.20 (2.60, 3.94) | 0.27 (0.15, 0.51) | 0.77 (0.71, 0.84) |
≥11.0 | 76.9 (60.7, 88.9) | 85.8 (82.9, 88.4) | 5.43 (4.21, 7.01) | 0.27 (0.15, 0.48) | 0.81 (0.75, 0.88) |
≥12.0 | 59.0 (42.1, 74.4) | 92.7 (90.4, 94.6) | 8.07 (5.53, 11.80) | 0.44 (0.30, 0.65) | 0.76 (0.68, 0.84) |
≥13.0 | 38.5 (23.4, 55.4) | 95.0 (93.0, 96.5) | 7.66 (4.56, 12.90) | 0.65 (0.51, 0.83) | 0.67 (0.59, 0.75) |
Predictive Scores | All-Cause Death (n = 133) | Adjusted Risk Ratio * (95% CI) | p Value | PE-Related Death (n = 39) | Adjusted Risk Ratio * (95% CI) | p Value |
---|---|---|---|---|---|---|
NEWS category | ||||||
Low (0–4) (n = 223) | 24 (18.1) | Ref. | 1 (2.6) | Ref. | ||
Medium (5–6) (n = 75) | 6 (4.5) | 0.71 (0.30, 1.68) | 0.440 | 0 (0.0) | N.A. * | |
High (≥7) (n = 398) | 103 (77.4) | 2.33 (1.54, 3.53) | <0.001 | 38 (97.4) | 21.87 (3.02, 158.35) | 0.002 |
NEWS cut off in this study | ||||||
NEWS < 9 (n = 417) | 44 (10.6) | Ref. | 4 (1.0) | Ref. | ||
NEWS ≥ 9 (n = 279) | 89 (31.9) | 2.96 (2.13, 4.12) | <0.001 | 35 (12.5) | 13.14 (4.72, 36.56) | <0.001 |
PESI classification | ||||||
I–II (n = 160) | 10 (6.3) | Ref. | 1 (0.6) | Ref. | ||
III (n = 191) | 22 (11.5) | 1.84 (0.89, 3.77) | 0.096 | 2 (1.0) | 1.67 (0.15, 18.31) | 0.674 |
IV (n = 151) | 27 (17.9) | 2.86 (1.43, 5.70) | 0.003 | 3 (2.0) | 3.20 (0.34, 30.44) | 0.311 |
V (n = 194) | 74 (38.1) | 6.00 (3.21, 11.24) | <0.001 | 33 (17.0) | 27.84 (3.85, 201.36) | 0.001 |
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Bumroongkit, C.; Tajarernmuang, P.; Trongtrakul, K.; Liwsrisakun, C.; Deesomchok, A.; Pothirat, C.; Theerakittikul, T.; Limsukon, A.; Niyatiwatchanchai, N.; Inchai, J.; et al. Predictive Ability of the National Early Warning Score in Mortality Prediction of Acute Pulmonary Embolism in the Southeast Asian Population. J. Cardiovasc. Dev. Dis. 2023, 10, 60. https://doi.org/10.3390/jcdd10020060
Bumroongkit C, Tajarernmuang P, Trongtrakul K, Liwsrisakun C, Deesomchok A, Pothirat C, Theerakittikul T, Limsukon A, Niyatiwatchanchai N, Inchai J, et al. Predictive Ability of the National Early Warning Score in Mortality Prediction of Acute Pulmonary Embolism in the Southeast Asian Population. Journal of Cardiovascular Development and Disease. 2023; 10(2):60. https://doi.org/10.3390/jcdd10020060
Chicago/Turabian StyleBumroongkit, Chaiwat, Pattraporn Tajarernmuang, Konlawij Trongtrakul, Chalerm Liwsrisakun, Athavudh Deesomchok, Chaicharn Pothirat, Theerakorn Theerakittikul, Atikun Limsukon, Nutchanok Niyatiwatchanchai, Juthamas Inchai, and et al. 2023. "Predictive Ability of the National Early Warning Score in Mortality Prediction of Acute Pulmonary Embolism in the Southeast Asian Population" Journal of Cardiovascular Development and Disease 10, no. 2: 60. https://doi.org/10.3390/jcdd10020060
APA StyleBumroongkit, C., Tajarernmuang, P., Trongtrakul, K., Liwsrisakun, C., Deesomchok, A., Pothirat, C., Theerakittikul, T., Limsukon, A., Niyatiwatchanchai, N., Inchai, J., & Chaiwong, W. (2023). Predictive Ability of the National Early Warning Score in Mortality Prediction of Acute Pulmonary Embolism in the Southeast Asian Population. Journal of Cardiovascular Development and Disease, 10(2), 60. https://doi.org/10.3390/jcdd10020060