Triantafyllidou Christina, Effraimidis Petros, Vougas Konstantinos, Agholme Jonas, Schimanke Mirjam, Cederquist Karin
Department of Internal Medicine, Section of Pulmonary Medicine, Vrinnevi Hospital, Norrköping, Sweden.
Biomedical Research Foundation of the Academy of Athens, Athens, Greece.
Clin Med Insights Circ Respir Pulm Med. 2023 Jan 24;17:11795484231152305. doi: 10.1177/11795484231152305. eCollection 2023.
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are the most devastating events in the course of the disease. Our aim was to investigate the value of early warning scoring systems: National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS) in AECOPD. This is a prospective observational study of patients with AECOPD who were admitted at hospital. The NEWS and MEWS scores were registered at admission (NEWS-d1, MEWS-d1) and on the second day (NEWS-d2, MEWS-d2). A nasopharyngeal and sputum sample was taken for culture. Follow-up was done at 3 and 6 months after hospitalization. Any possible correlations between NEWS and MEWS and other parameters of COPD were explored. A cohort of 64 patients were included. In-hospital mortality was 4.7% while total mortality at 6 months was 26%. We did not find any significant correlation between in-hospital mortality and any of the scores but we could show a higher mortality and more frequent AECOPD at 6 months of follow-up for those with higher NEWS-d2. NEWS-d2 was associated with higher pCO at presentation and a more frequent use of NIV. Higher NEWS-d1 and NEWS-d2 were predictive of a longer hospital stay. The presence of pathogens in the nasopharyngeal sample was related with a higher reduction of both scores on the second day. We therefore support the superiority of NEWS in the evaluation of hospitalized patients with AECOPD. A remaining high NEWS at the second day of hospital stay signals a high risk of hypercapnia and need of NIV but also higher mortality and more frequent exacerbations at 6 months after AECOPD.
慢性阻塞性肺疾病急性加重（AECOPD）是该疾病病程中最具破坏性的事件。我们的目的是研究早期预警评分系统：国家早期预警评分（NEWS）和改良早期预警评分（MEWS）在AECOPD中的价值。这是一项对入住医院的AECOPD患者进行的前瞻性观察性研究。在入院时（NEWS-d1、MEWS-d1）和第二天（NEWS-d2、MEWS-d2）记录NEWS和MEWS评分。采集鼻咽和痰液样本进行培养。在住院后3个月和6个月进行随访。探讨NEWS和MEWS与慢性阻塞性肺疾病其他参数之间的任何可能相关性。纳入了64例患者队列。住院死亡率为4.7%，而6个月时的总死亡率为26%。我们未发现住院死亡率与任何评分之间存在显著相关性，但我们可以显示，随访6个月时，NEWS-d2较高的患者死亡率更高，AECOPD更频繁。NEWS-d2与就诊时较高的动脉血二氧化碳分压（pCO）及更频繁使用无创通气（NIV）相关。较高的NEWS-d1和NEWS-d2可预测住院时间更长。鼻咽样本中病原体的存在与第二天两个评分的更大降幅相关。因此，我们支持NEWS在评估住院AECOPD患者方面的优越性。住院第二天仍保持较高的NEWS表明存在高碳酸血症的高风险以及需要使用NIV，同时也表明AECOPD后6个月死亡率更高且病情加重更频繁。
