Cavalier J, et al. Kidney Med. 2022;doi:10.1016/j.xkme.2022.100506.
Cavalier J, et al. Kidney Med. 2022;doi:10.1016/j.xkme.2022.100506.
The National Early Warning Score performs better among patients with kidney failure than other hospitalized patients, according to a research letter published in Kidney Medicine.
Designed to be a points-based clinical decision tool, the National Early Warning Score (NEWS) uses the following vital signs: systolic blood pressure, respiratory rate, temperature, pulse oximetry, heart rate, use of supplemental oxygen and level of consciousness.
“While studies have shown the NEWS and other early warning scores to have adequate predictive performance, the utility of these scores in clinical subpopulations is less well established,” Joanna Cavalier, MD, from the department of medicine at Duke University, and colleagues wrote. “Early warning scores have been examined in kidney transplant recipients, but their use in patients with kidney failure treated with maintenance hemodialysis has only been examined as subpopulation analyses in larger studies.”
Researchers aimed to determine the effectiveness of the NEWS among patients on maintenance hemodialysis who were hospitalized in 2019 at an academic medical center with more than 1,000 beds. Death while on the medical or surgical floor or escalation of care to the ICU served as the primary outcome. All data were derived from electronic health records.
Using last known vital measurements, researchers mimicked continuous monitoring by calculating the NEWS in 2-hour intervals. During the next 12 hours, researchers measured the predictive performance of the time-varying risk score, stratified by kidney failure status. Performance was measured using the area under the receiver operating characteristic curve (AUROC) and area under the precision recall curve (AUPRC).
Additionally, researchers measured the relationship between each vital sign used in the NEWS with the primary outcome.
In total, researchers identified 28,905 admissions during the study period. Of these admissions, 1,343 were patients with kidney failure on maintenance dialysis.
Analyses revealed the NEWS better predicted ICU transfer or mortality in 12 hours among patients with kidney failure vs. patients without kidney failure (AUROC of 0.749 vs. 0.702, respectively, and AUPRC of 0.081 vs. 0.048, respectively). In the analysis of vital signs, researchers observed high systolic blood pressure tended to be relatively protective against decompensation in patients with kidney failure and a high heart rate was more predictive of decompensation among patients with kidney failure.
“This study is the first to establish that the widely used NEWS not only performs well in patients with kidney failure on maintenance dialysis, but better than in other hospitalized patients,” Cavalier and colleagues wrote. They added, “Given the NEWS’s predictive performance in this patient population, a customized early warning score for patients with kidney failure on maintenance dialysis is not necessary. Institutions can use the NEWS to reliably help predict decompensation in patients with kidney failure on maintenance dialysis.”
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