López-Izquierdo Raúl, Martín-Rodríguez Francisco, Anel Cuadrillero Rut, López Villar Caterina, Sobradillo Castrodeza Nieves, Villahoz Cancho Isabel, Santos Castro Pedro Á, Ingelmo Astorga Elisa A, Sanz-García Ancor, Del Pozo Vegas Carlos
Emergency Department, Hospital Universitario Rio Hortega, Gerencia Regional de Salud de Castilla y León, Valladolid, Spain; Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.
Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Prehospital Critical Care, Emergency Medical Services, Gerencia Regional de Salud de Castilla y León, Valladolid, Spain.
Am J Emerg Med. 2025 Apr;90:16-22. doi: 10.1016/j.ajem.2025.01.011. Epub 2025 Jan 6.
The study of the inclusion of new variables in already existing early warning scores is a growing field. The aim of this work was to determine how capnometry measurements, in the form of end-tidal CO2 (ETCO2) and the perfusion index (PI), could improve the National Early Warning Score (NEWS2).
A secondary, prospective, multicenter, cohort study was undertaken in adult patients with unselected acute diseases who needed continuous monitoring in the emergency department (ED), involving two tertiary hospitals in Spain from October 1, 2022, to June 30, 2023. The primary outcome was 30-day all-cause in-hospital mortality. Demographics and vital signs necessary for NEWS2, ETCO2 and PI were collected.
A total of 687 patients were included in the study. The median age was 79 years (IQR: 69-86), and 36.7 % were females, with an in-hospital mortality rate of 6.7 %. The NEWS2 score was 7 points for nonsurvivors and 4 points for survivors (p < 0.001). The EtCO2 levels were 30 mmHg (26-35) and 23 mmHg (16-30), and the PI levels were 4.7% (2.2-8.1) and 2.5 % (0.98-4.4) for survivors and nonsurvivors, respectively (both p < 0.001). The discrimination capacity of NEWS2 was AUC = 0.769 (95 % CI: 0.707-0.831), that of EtCO2 + PI was AUC = 0.737 (95 % CI: 0.66-0.814), and that of NEWS2 + ETCO2 + PI was AUC = 0.804 (95 % CI: 0.745-0.863).
The present study findings indicate that the PI and ETCO2 improved the ability of the NEWS2 to predict 30-day in-hospital mortality. The novel association of the NEWS2 with the PI and ETCO2 should be considered since it could improve the identification of patients at risk of clinical worsening.
在现有早期预警评分中纳入新变量的研究是一个不断发展的领域。本研究的目的是确定以呼气末二氧化碳（EtCO2）和灌注指数（PI）形式的二氧化碳监测测量如何能改进国家早期预警评分（NEWS2）。
在2022年10月1日至2023年6月30日期间，对西班牙两家三级医院急诊科需要持续监测的未选择的急性疾病成年患者进行了一项二次、前瞻性、多中心队列研究。主要结局是30天全因住院死亡率。收集了NEWS2、EtCO2和PI所需的人口统计学和生命体征数据。
共纳入687例患者。中位年龄为79岁（四分位间距：69 - 86岁），女性占36.7%，住院死亡率为6.7%。非幸存者的NEWS2评分为7分，幸存者为4分（p < 0.001）。幸存者和非幸存者的EtCO2水平分别为30 mmHg（26 - 35）和23 mmHg（16 - 30），PI水平分别为4.7%（2.2 - 8.1）和2.5%（0.98 - 4.4）（均p < 0.001）。NEWS2的鉴别能力为AUC = 0.769（95%CI：0.707 - 0.831），EtCO2 + PI为AUC = 0.737（95%CI：0.66 - 0.814），NEWS2 + EtCO2 + PI为AUC = 0.804（95%CI：0.745 - 0.863）。
本研究结果表明，PI和EtCO2提高了NEWS2预测30天住院死亡率的能力。应考虑NEWS2与PI和EtCO2的新关联，因为它可以改善对临床病情恶化风险患者的识别。
