Early warning score: a dynamic marker of severity and prognosis in patients with Gram-negative bacteraemia and sepsis. Issue 1 (December 2016)

• Record Type: Journal Article
• Authors: Albur, Mahableshwar; Hamilton, Fergus; MacGowan, Alasdair
• Is Part Of: Annals of clinical microbiology and antimicrobials. Volume 15:Issue 1(2016)
• Page Start: 1
• Page End: 10
• Publication Date: 2016-12
• Subjects: Gram-negative bacteraemia -- Early warning score -- Clinical outcome; Medical microbiology -- Periodicals; Anti-infective agents -- Periodicals; 616.9041
• DOI: 10.1186/s12941-016-0139-z
• Languages: English
• ISSNs: 1476-0711

Abstract

Abstract Background Early Warning Score (EWS) is a physiological composite score of six bedside vital parameters, routinely used in UK hospitals. We evaluated the prognostic ability of EWS in Gram-negative bacteraemia causing sepsis. Methods We prospectively evaluated EWS as a marker of severity and prognosis in adult patients with Gram-negative bacteraemia. All adult patients with Gram-negative bacteraemia admitted to our tertiary Teaching hospital of the National Health Service in England were enrolled over 1 year period. The highest daily EWS score was recorded from 7 days before to 14 days after the date of onset of bacteraemia. The primary outcome was 28-day mortality. Main results A total of 245 consecutive adult patients with Gram-negative bacteraemia with sepsis were enrolled. On multivariate analysis, following variables were associated with death for every single unit change (odds ratio in the brackets): higher age (1.05), lower mean arterial pressure (1.03), lower serum bicarbonate (1.08), higher EWS (1.27), higher SOFA score (1.36), hospital-onset of infection (5.43) and need for vasopressor agents (16.4). EWS on day 0, 1, 2, and average 14-day score were significantly higher in patients who died by 28 days from the onset of bacteraemia [95 % CI 0.4–0.6]p < 0.001. A stepwise rise in EWS and failure of improvement in EWS by 2 points 48 h after the onset of bacteraemia were associated with poor outcome. Conclusion EWS is a simple and cost-effective bedside tool for the assessment of severity and prognosis of sepsis caused by Gram-negative bacteraemia.