Early warning score: A dynamic marker of severity and prognosis in patients with Gram-negative bacteraemia and sepsis

Mahableshwar Albur; Fergus Hamilton; Alasdair P. MacGowan

doi:10.1186/s12941-016-0139-z

Early warning score: A dynamic marker of severity and prognosis in patients with Gram-negative bacteraemia and sepsis

Mahableshwar Albur^*, Fergus Hamilton, Alasdair P. MacGowan

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

18 Citations (Scopus)

Abstract

Background: Early Warning Score (EWS) is a physiological composite score of six bedside vital parameters, routinely used in UK hospitals. We evaluated the prognostic ability of EWS in Gram-negative bacteraemia causing sepsis. Methods: We prospectively evaluated EWS as a marker of severity and prognosis in adult patients with Gram-negative bacteraemia. All adult patients with Gram-negative bacteraemia admitted to our tertiary Teaching hospital of the National Health Service in England were enrolled over 1 year period. The highest daily EWS score was recorded from 7 days before to 14 days after the date of onset of bacteraemia. The primary outcome was 28-day mortality. Main results: A total of 245 consecutive adult patients with Gram-negative bacteraemia with sepsis were enrolled. On multivariate analysis, following variables were associated with death for every single unit change (odds ratio in the brackets): higher age (1.05), lower mean arterial pressure (1.03), lower serum bicarbonate (1.08), higher EWS (1.27), higher SOFA score (1.36), hospital-onset of infection (5.43) and need for vasopressor agents (16.4). EWS on day 0, 1, 2, and average 14-day score were significantly higher in patients who died by 28 days from the onset of bacteraemia [95 % CI 0.4-0.6] p < 0.001. A stepwise rise in EWS and failure of improvement in EWS by 2 points 48 h after the onset of bacteraemia were associated with poor outcome. Conclusion: EWS is a simple and cost-effective bedside tool for the assessment of severity and prognosis of sepsis caused by Gram-negative bacteraemia.

Original language	English
Article number	23
Journal	Annals of Clinical Microbiology and Antimicrobials
Volume	15
Issue number	1
DOIs	https://doi.org/10.1186/s12941-016-0139-z
Publication status	Published - 2016

Bibliographical note

Funding Information:
We would like to thank Dr. Iain Weir, Senior Lecturer, Department of Mathematics, University of West of England for the statistical analysis of this research project and Mrs. Margaret Agg, senior data manager, Information Technology department, North Bristol NHS Trust for helping with data management systems. 1. North Bristol NHS Trust, Bristol UK. 2. University of Bristol, UK.

Publisher Copyright:
© 2016 Albur et al.

Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.

Keywords

Clinical outcome
Early warning score
Gram-negative bacteraemia

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@article{b91c78c29fb24eb3a63878531c79c207,

title = "Early warning score: A dynamic marker of severity and prognosis in patients with Gram-negative bacteraemia and sepsis",

abstract = "Background: Early Warning Score (EWS) is a physiological composite score of six bedside vital parameters, routinely used in UK hospitals. We evaluated the prognostic ability of EWS in Gram-negative bacteraemia causing sepsis. Methods: We prospectively evaluated EWS as a marker of severity and prognosis in adult patients with Gram-negative bacteraemia. All adult patients with Gram-negative bacteraemia admitted to our tertiary Teaching hospital of the National Health Service in England were enrolled over 1 year period. The highest daily EWS score was recorded from 7 days before to 14 days after the date of onset of bacteraemia. The primary outcome was 28-day mortality. Main results: A total of 245 consecutive adult patients with Gram-negative bacteraemia with sepsis were enrolled. On multivariate analysis, following variables were associated with death for every single unit change (odds ratio in the brackets): higher age (1.05), lower mean arterial pressure (1.03), lower serum bicarbonate (1.08), higher EWS (1.27), higher SOFA score (1.36), hospital-onset of infection (5.43) and need for vasopressor agents (16.4). EWS on day 0, 1, 2, and average 14-day score were significantly higher in patients who died by 28 days from the onset of bacteraemia [95 % CI 0.4-0.6] p < 0.001. A stepwise rise in EWS and failure of improvement in EWS by 2 points 48 h after the onset of bacteraemia were associated with poor outcome. Conclusion: EWS is a simple and cost-effective bedside tool for the assessment of severity and prognosis of sepsis caused by Gram-negative bacteraemia.",

keywords = "Clinical outcome, Early warning score, Gram-negative bacteraemia",

author = "Mahableshwar Albur and Fergus Hamilton and MacGowan, {Alasdair P.}",

note = "Funding Information: We would like to thank Dr. Iain Weir, Senior Lecturer, Department of Mathematics, University of West of England for the statistical analysis of this research project and Mrs. Margaret Agg, senior data manager, Information Technology department, North Bristol NHS Trust for helping with data management systems. 1. North Bristol NHS Trust, Bristol UK. 2. University of Bristol, UK. Publisher Copyright: {\textcopyright} 2016 Albur et al. Copyright: Copyright 2017 Elsevier B.V., All rights reserved.",

year = "2016",

doi = "10.1186/s12941-016-0139-z",

language = "English",

volume = "15",

journal = "Annals of Clinical Microbiology and Antimicrobials",

issn = "1476-0711",

publisher = "BioMed Central",

number = "1",

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TY - JOUR

T1 - Early warning score

T2 - A dynamic marker of severity and prognosis in patients with Gram-negative bacteraemia and sepsis

AU - Albur, Mahableshwar

AU - Hamilton, Fergus

AU - MacGowan, Alasdair P.

N1 - Funding Information: We would like to thank Dr. Iain Weir, Senior Lecturer, Department of Mathematics, University of West of England for the statistical analysis of this research project and Mrs. Margaret Agg, senior data manager, Information Technology department, North Bristol NHS Trust for helping with data management systems. 1. North Bristol NHS Trust, Bristol UK. 2. University of Bristol, UK. Publisher Copyright: © 2016 Albur et al. Copyright: Copyright 2017 Elsevier B.V., All rights reserved.

PY - 2016

Y1 - 2016

N2 - Background: Early Warning Score (EWS) is a physiological composite score of six bedside vital parameters, routinely used in UK hospitals. We evaluated the prognostic ability of EWS in Gram-negative bacteraemia causing sepsis. Methods: We prospectively evaluated EWS as a marker of severity and prognosis in adult patients with Gram-negative bacteraemia. All adult patients with Gram-negative bacteraemia admitted to our tertiary Teaching hospital of the National Health Service in England were enrolled over 1 year period. The highest daily EWS score was recorded from 7 days before to 14 days after the date of onset of bacteraemia. The primary outcome was 28-day mortality. Main results: A total of 245 consecutive adult patients with Gram-negative bacteraemia with sepsis were enrolled. On multivariate analysis, following variables were associated with death for every single unit change (odds ratio in the brackets): higher age (1.05), lower mean arterial pressure (1.03), lower serum bicarbonate (1.08), higher EWS (1.27), higher SOFA score (1.36), hospital-onset of infection (5.43) and need for vasopressor agents (16.4). EWS on day 0, 1, 2, and average 14-day score were significantly higher in patients who died by 28 days from the onset of bacteraemia [95 % CI 0.4-0.6] p < 0.001. A stepwise rise in EWS and failure of improvement in EWS by 2 points 48 h after the onset of bacteraemia were associated with poor outcome. Conclusion: EWS is a simple and cost-effective bedside tool for the assessment of severity and prognosis of sepsis caused by Gram-negative bacteraemia.

AB - Background: Early Warning Score (EWS) is a physiological composite score of six bedside vital parameters, routinely used in UK hospitals. We evaluated the prognostic ability of EWS in Gram-negative bacteraemia causing sepsis. Methods: We prospectively evaluated EWS as a marker of severity and prognosis in adult patients with Gram-negative bacteraemia. All adult patients with Gram-negative bacteraemia admitted to our tertiary Teaching hospital of the National Health Service in England were enrolled over 1 year period. The highest daily EWS score was recorded from 7 days before to 14 days after the date of onset of bacteraemia. The primary outcome was 28-day mortality. Main results: A total of 245 consecutive adult patients with Gram-negative bacteraemia with sepsis were enrolled. On multivariate analysis, following variables were associated with death for every single unit change (odds ratio in the brackets): higher age (1.05), lower mean arterial pressure (1.03), lower serum bicarbonate (1.08), higher EWS (1.27), higher SOFA score (1.36), hospital-onset of infection (5.43) and need for vasopressor agents (16.4). EWS on day 0, 1, 2, and average 14-day score were significantly higher in patients who died by 28 days from the onset of bacteraemia [95 % CI 0.4-0.6] p < 0.001. A stepwise rise in EWS and failure of improvement in EWS by 2 points 48 h after the onset of bacteraemia were associated with poor outcome. Conclusion: EWS is a simple and cost-effective bedside tool for the assessment of severity and prognosis of sepsis caused by Gram-negative bacteraemia.

KW - Clinical outcome

KW - Early warning score

KW - Gram-negative bacteraemia

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U2 - 10.1186/s12941-016-0139-z

DO - 10.1186/s12941-016-0139-z

M3 - Article (Academic Journal)

C2 - 27071911

AN - SCOPUS:85007507491

SN - 1476-0711

VL - 15

JO - Annals of Clinical Microbiology and Antimicrobials

JF - Annals of Clinical Microbiology and Antimicrobials

IS - 1

M1 - 23

ER -

Early warning score: A dynamic marker of severity and prognosis in patients with Gram-negative bacteraemia and sepsis

Abstract

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