The following is a summary of “Use of illness severity scores to predict mortality in interstitial lung disease patients hospitalised with acute respiratory deterioration,” published in the March 2023 issue of Pulmonology by Williams et al.
The prognosis of patients hospitalized with acute respiratory deterioration (ARD) in interstitial lung disease (ILD) is poor. There was limited data on using illness severity scores in prognostication, and factors predicting adverse outcomes still need to be fully understood. For a prospective observational cohort study, researchers sought to investigate using the CURB-65 and NEWS-2 severity scores in predicting mortality following ARD-ILD hospitalization. Using a prospective methodology, they sought to validate previously determined cut-offs from a retrospective study cohort.
The study included all adults (≥18 years) hospitalized with ARD-ILD in Bristol, UK (n = 179). The 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.
The GAP score showed some merit in predicting 30-day mortality (AUC = 0.64, P = 0.015). CURB-65 showed modest predictive value for in-hospital (AUC = 0.72, P < 0.001) and 90-day mortality (AUC = 0.67, P < 0.001). NEWS-2 showed higher predictive value for in-hospital (AUC = 0.80, P < 0.001) and 90-day mortality (AUC = 0.75, P < 0.001). An optimal derived cut-off of ≥6.5 for NEWS-2 was found to be sensitive and specific for predicting in-hospital (83% and 63%) and 90-day (73% and 72%) mortality. In exploratory analyses, adding the GAP score improved the predictive ability of NEWS-2 against 30-day mortality and CURB-65 across all periods.
For forecasting in-hospital mortality and predicting mortality within 90 days, NEWS-2 has a good discriminating value. The best NEWS-2 cut-off value discovered was the same as in a previous retrospective cohort, indicating the NEWS-2 score had the potential as a predictor of death after hospitalization for ARD-ILD.
Source: resmedjournal.com/article/S0954-6111(23)00108-7/fulltext