Use of illness severity scores to predict mortality in interstitial lung disease patients hospitalised with acute respiratory deterioration

Rachel L Williams, Catherine Hyams, Joe Robertshaw, Maria Garcia Gonzalez, Zsuzsa Szasz-Benczur, Paul White, Nick A Maskell, Adam Finn, Shaney L Barratt*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Introduction
Hospitalisations relating to acute respiratory deteriorations (ARD) in Interstitial Lung Disease (ILD) have poor outcomes. Factors predicting adverse outcomes are not fully understood and data addressing the use of illness severity scores in prognostication are limited.

Objective
To investigate the use of CURB-65 and NEWS-2 severity scores in the prediction of mortality following ARD-ILD hospitalisation, using prospective methodology and to validate previously determined cut-offs, derived from a retrospective study cohort.

Methods
A dual-centre prospective observational cohort study of all adults (≥18y) hospitalised with ARD-ILD in Bristol, UK (n = 179). Gender-Age-Physiology (GAP), CURB-65 and NEWS-2 scores were calculated for each eligible admission.

Receiver operating characteristics (ROC) curve analysis was used to quantify the strength of discrimination for NEWS-2 and CURB-65 scores. Univariable and multivariable logistic regression analyses were performed to explore the relationship between baseline severity scores and mortality.

Results
GAP showed some merit at predicting 30-day mortality (AUC = 0.64, P = 0.015); whereas CURB-65 showed modest predictive value for in-hospital (AUC = 0.72, P 
Conclusion
NEWS-2 has good discriminatory value for predicting in-hospital mortality and moderate discriminatory value for predicting 90-day mortality. The optimal NEWS-2 cut-off value determined was the same as in a previous retrospective cohort, confirming the NEWS-2 score shows promise in predicting mortality following ARD-ILD hospitalisation.
Original languageEnglish
Article number107220
JournalRespiratory Medicine
Volume212
Early online date29 Mar 2023
DOIs
Publication statusE-pub ahead of print - 29 Mar 2023

Bibliographical note

Funding Information:
CH is Principal Investigator of the AvonCAP study, which is an investigator-led University of Bristol study funded by Pfizer, Inc, and is currently a member of the BTS Pulmonary Infection Specialty Advisory Group (SAG). AF is a member of the Joint Committee on Vaccination and Immunization (JCVI) and was chair of the World Health Organization European Technical Advisory Group of Experts (WHO ETAGE) committee until 2023. In addition to receiving funding from Pfizer as Chief Investigator for this study, he leads another project investigating transmission of respiratory bacteria in families jointly funded by Pfizer and the Gates Foundation.The other authors declare no competing interests.

Publisher Copyright:
© 2023 The Authors

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