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Derivation and validation of modified early warning score plus SpO2/FiO2 score for predicting acute deterioration of patients with hematological malignancies

Korean Journal of Internal Medicine 2020년 35권 6호 p.1477 ~ 1488
이주리, 정연경, 김화정, 고윤석, 임채만, 홍상범, 허진원,
소속 상세정보
이주리 ( Lee Ju-Ry ) - University of Ulsan College of Medicine Asan Medical Center Medical Emergency Team
정연경 ( Jung Youn-Kyoung ) - University of Ulsan College of Medicine Asan Medical Center Medical Emergency Team
김화정 ( Kim Hwa-Jung ) - University of Ulsan College of Medicine Asan Medical Center Department of Clinical Epidemiology and Biostatistics
고윤석 ( Koh Youn-Suck ) - University of Ulsan College of Medicine Asan Medical Center Department of Pulmonary and Critical Care Medicine
임채만 ( Lim Chae-Man ) - University of Ulsan College of Medicine Asan Medical Center Department of Pulmonary and Critical Care Medicine
홍상범 ( Hong Sang-Bum ) - University of Ulsan College of Medicine Asan Medical Center Department of Pulmonary and Critical Care Medicine
허진원 ( Huh Jin-Won ) - University of Ulsan College of Medicine Asan Medical Center Department of Pulmonary and Critical Care Medicine

Abstract


Background/Aims: Scoring systems play an important role in predicting intensive care unit (ICU) admission or estimating the risk of death in critically ill patients with hematological malignancies. We evaluated the modified early warning score (MEWS) for predicting ICU admissions and in-hospital mortality among at-risk patients with hematological malignancies and developed an optimized MEWS.

Methods: We retrospectively analyzed derivation cohort patients with hematological malignancies who were managed by a medical emergency team (MET) in the general ward and prospectively validated the data. We compared the traditional MEWS with the MEWS plus SpO2/FiO2 (MEWS_SF) score, which were calculated at the time of MET contact.

Results: In the derivation cohort, the areas under the receiver-operating characteristic (AUROC) curves were 0.81 for the MEWS (95% confidence interval [CI], 0.76 to 0.87) and 0.87 for the MEWS_SF score (95% CI, 0.87 to 0.92) for predicting ICU admission. The AUROC curves were 0.70 for the MEWS (95% CI, 0.63 to 0.77) and 0.76 for the MEWS_SF score (95% CI, 0.70 to 0.83) for predicting in-hospital mortality. In the validation cohort, the AUROC curves were 0.71 for the MEWS (95% CI, 0.66 to 0.77) and 0.83 for the MEWS_SF score (95% CI, 0.78 to 0.87) for predicting ICU admission. The AUROC curves were 0.64 for the MEWS (95% CI, 0.57 to 0.70) and 0.74 for the MEWS_SF score (95% CI, 0.69 to 0.80) for predicting in-hospital mortality.

Conclusions: Compared to the traditional MEWS, the MEWS_SF score may be a useful tool that can be used in the general ward to identify deteriorating patients with hematological malignancies.

키워드

Clinical deterioration; Hematologic neoplasms; Modified early warning score; Prediction; SpO2/FiO2 ratio

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