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Use of illness severity scores to predict mortality in interstitial lung disease patients hospitalised with acute respiratory deterioration

Williams, Rachel L; Hyams, Catherine; Robertshaw, Joe; Garcia Gonzalez, Maria; Szasz-Benczur, Zsuzsa; White, Paul; Maskell, Nick A; Finn, Adam; Barratt, Shaney L

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Authors

Rachel L Williams

Catherine Hyams

Joe Robertshaw

Maria Garcia Gonzalez

Zsuzsa Szasz-Benczur

Paul White Paul.White@uwe.ac.uk
Professor in Applied Statistics

Nick A Maskell

Adam Finn

Shaney L Barratt



Abstract

Introduction: Hospitalisations relating to acute respiratory deteriorations (ARD) in Interstitial Lung Disease (ILD) have poor outcomes. Factors predicting adverse outcomes are not fully understood and data addressing the use of illness severity scores in prognostication are limited. Objective: To investigate the use of CURB-65 and NEWS-2 severity scores in the prediction of mortality following ARD-ILD hospitalisation, using prospective methodology and to validate previously determined cut-offs, derived from a retrospective study cohort. Methods: A dual-centre prospective observational cohort study of all adults (≥18y) hospitalised with ARD-ILD in Bristol, UK (n = 179). 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. Results: GAP showed some merit at predicting 30-day mortality (AUC = 0.64, P = 0.015); whereas 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), with an optimal derived cut-off ≥6.5 found to be sensitive and specific for predicting in-hospital (83% and 63%) and 90-day (73% and 72%) mortality. In exploratory analyses, GAP score addition improved the predictive ability of NEWS-2 against 30-day mortality and CURB-65 across all time-periods. Conclusion: NEWS-2 has good discriminatory value for predicting in-hospital mortality and moderate discriminatory value for predicting 90-day mortality. The optimal NEWS-2 cut-off value determined was the same as in a previous retrospective cohort, confirming the NEWS-2 score shows promise in predicting mortality following ARD-ILD hospitalisation.

Journal Article Type Article
Acceptance Date Mar 17, 2023
Online Publication Date Mar 29, 2023
Publication Date Jun 1, 2023
Deposit Date Mar 17, 2023
Publicly Available Date Apr 17, 2023
Journal Respiratory Medicine
Print ISSN 0954-6111
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 212
Pages 107220
DOI https://doi.org/10.1016/j.rmed.2023.107220
Keywords Interstitial lung disease; lung disease; acute respiratory deterioration; Ilness severity; Illness severity score
Public URL https://uwe-repository.worktribe.com/output/10559118
Publisher URL https://www.resmedjournal.com/

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