Utilidad predictiva de mortalidad de las escalas qSOFA, NEWS y GYM en el paciente anciano con infección en urgencias: estudio EDEN-5

Abstract

Objective

To analyze the prognostic accuracy of the scores NEWS, qSOFA, GYM used in hospital emergency department (ED) in the assessment of elderly patients who consult for an infectious disease.

Methods

Data from the EDEN (Emergency Department and Elderly Needs) cohort were used. This retrospective cohort included all patients aged ≥ 65 years seen in 52 Spanish EDs during two weeks (from 1/4/2019 to 7/4/2019 and 30/3/2020 to 5/4/2020) with an infectious disease diagnosis in the emergency department. Demographic variables, comorbidities, Charlson and Barthel index and needed scores parameters were recorded. The predictive capacity for 30-day mortality of each scale was estimated by calculating the area under the receiver operating characteristic (ROC) curve, and sensitivity and specificity were calculated for different cut-off points. The primary outcome variable was 30-day mortality.

Results

Six thousand fifty-four patients were analyzed. Median age was 80 years (IQR 73-87) and 45.3% women. Nine hundred and ninety-three (16.4%) patients died. NEWS score had better AUC than qSOFA (0.765; 95% CI: 0.725-0.806, vs. 0.700; 95% CI: 0.653-0.746; P < .001) and GYM (0.716; 95% CI: 0.675-0.758; P = .024), and there was no difference between qSOFA and GYM (P = .345). The highest sensitivity scores for 30-day mortality were GYM ≥ 1 point (85.4%) while the qSOFA score ≥ 2 points showed high specificity. In the case of the NEWS scale, the cut-off point ≥ 4 showed high sensitivity, while the cut-off point NEWS ≥ 8 showed high specificity.

Conclusion

NEWS score showed the highest predictive capacity for 30-day mortality. GYM score ≥ 1 showed a great sensitivity, while qSOFA ≥ 2 scores provide the highest specificity but lower sensitivity.