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 journalArticle (Academic Journal)peer-review

7 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 languageEnglish
Article number23
JournalAnnals of Clinical Microbiology and Antimicrobials
Volume15
Issue number1
DOIs
Publication statusPublished - 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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