A validation study of three early warning scores in early identification of gastric cancer patients with deteriorating condition after gastrectomy.

IF 2.5 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY BMC Gastroenterology Pub Date : 2025-02-24 DOI:10.1186/s12876-024-03586-0

Xinli Shi, Huijuan Jie, Naifa Li, Qiongshan Liu, Yue Wang, Changquan Wu, Wenwen Jiang, Bolin Zhang, Shurong Lai, Honglu Xu

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Abstract

Objectives: Early warning scores (EWS) aim to rapidly identify patients at risk of critical illness or life-threatening events before deterioration occurs in clinical settings. This study aims to validate the ability of three commonly used early warning scores, namely the National Early Warning Score (NEWS), the Early Warning Score (SEWS), and the Modified Early Warning Score (MEWS), to identify patients with deterioration after gastric cancer resection in general wards.

Methods: This retrospective case-control study included 110 patients who experienced clinical deterioration after gastrectomy for gastric cancer as case group, and 745 patients without deterioration as control group from a tertiary hospital in Guangdong Province, China. The discriminating ability (receiver operating characteristic curves), calibration (goodness-of-fit test) and net benefit (clinical decision curves) of the three EWS (NEWS, SEWS, MEWS) were explored to compare their early warning performance for patients at risk of post-operative deterioration.

Results: MEWS (goodness-of-fit p = 0.123 > 0.05) and SEWS (goodness-of-fit p = 0.235 > 0.05) both demonstrate good calibration and good discrimination ability (AUC 0.710, 95% CI 0.654-0.766;AUC 0.756, 95% CI 0.701-0.811). In contrast, NEWS not only has good calibration (goodness-of-fit p = 0.283 > 0.05) but also exhibits the best discrimination ability among the three scoring systems (AUC 0.835, 95% CI 0.785-0.884) and the highest net benefit.

Conclusion: Overall, NEWS may be more suitable for identifying gastric cancer patients at risk of post-operative clinical deterioration, as the early warning scoring model with best performance currently for post-gastrectomy observation.

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三种预警评分在胃癌切除术后病情恶化患者早期识别中的有效性研究。

目的：早期预警评分（EWS）旨在在临床环境恶化之前快速识别有危重疾病或危及生命事件风险的患者。本研究旨在验证三种常用的预警评分，即国家预警评分（NEWS）、预警评分（SEWS）和修正预警评分（MEWS）对普通病房胃癌切除术后恶化患者的识别能力。方法：采用回顾性病例对照研究，选取广东省某三级医院110例胃癌切除术后出现临床恶化的患者为病例组，745例未出现临床恶化的患者为对照组。探讨三种EWS （NEWS、SEWS、MEWS）的鉴别能力（受试者工作特征曲线）、校准（拟合优度检验）和净效益（临床决策曲线），比较其对术后恶化风险患者的预警能力。结果：MEWS（拟合优度p = 0.123 > 0.05）和SEWS（拟合优度p = 0.235 > 0.05）均具有良好的校准和识别能力（AUC 0.710, 95% CI 0.654-0.766;AUC 0.756, 95% CI 0.701-0.811）。相比之下，NEWS不仅具有良好的校准性（拟合优度p = 0.283 > 0.05），而且在三个评分系统中表现出最好的区分能力（AUC 0.835, 95% CI 0.785-0.884）和最高的净效益。结论：总的来说，NEWS可能更适合于识别胃癌患者术后临床恶化的风险，是目前在胃切除术后观察中表现最好的预警评分模型。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMC Gastroenterology 医学-胃肠肝病学

CiteScore

4.20

自引率

0.00%

发文量

465

审稿时长

6 months

期刊介绍： BMC Gastroenterology is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of gastrointestinal and hepatobiliary disorders, as well as related molecular genetics, pathophysiology, and epidemiology.