Prognostic value of the NEWS-L score in patients admitted in the emergency department with decompensated heart failure

Prognostic Value of the NEWS-L Score in Patients admitted in the Emergency Department with Decompensated Heart Failure Introduction: National Early Warning Score is a scoring system that shows mortality and morbidity in many critical diseases, and the National Early Warning Score - Lactate Score was created by adding lactate values to this scoring. In this study, we aimed that whether the National Early Warning Score - Lactate Score could be used or not as a prognostic indicator in patients with decompensated heart failure, which is one of the patient groups frequently admitted to the emergency department. Materials and Method: The patients with decompensated heart failure who applied to Dokuz Eylül University Hospital Adult Emergency Department between 01.10.2020 and 31.12.2020 were evaluated. While patients with a definite diagnosis of decompensated heart failure were enrolled in the study, patients with an other active diseases such as pulmonary embolism and pneumonia and patients with no measured lactate values were excluded. Patients were divided into good and poor prognosis groups according to emergency service outcomes. As indicators of poor prognosis, following criteria determined; impairment of the patient's state of consciousness, needing at least one of noninvasive mechanical ventilation, invasive mechanical ventilation, intravenous inotropic therapy, intravenous vasopressor therapy, Hs-Troponin I values above normal values, admission to intensive care unit, application of cardiopulmonary resuscitation and death. Patients who did not meet at least one of the poor prognosis criteria were included in the good prognosis group. The results were present with a p value of 95% confidence interval (CI) for each variable. Statistical significance level was determined as p <0.05. Results: Study data were analyzed over a total of 141 applications from 130 patients. 42.2% of the patients were male and 50.8% were female. The mean age of the patients was 72.6 ± 11.8. The most common comorbid diseases of the patients were hypertension (82%) and diabetes mellitus (50%). 35% of the patients were in the good prognosis group and 65% were in the poor prognosis group. There was no difference between the groups in terms of mean age and gender. There was a statistically significant difference between the good and poor prognosis groups in terms of NEWS and NEWS-L scores (p <0.001). For NEWS-L scores, the median value of NEWS-L was 4.7 (IQR: 2.3-7.2) in the good prognosis group and 8.0 (IQR: 5.2-10.4) in the poor prognosis group (p <0.001). There was a statistically significant difference between the lactate (IQR; 1.4-2.4, 1.4-3, p=0.048), BNP (IQR; 420-1672, 699-2259, p=0.023) and Hs-Troponin I (IQR; 9.9-24.3, 17.7-147.4, p<0.001) values in the good and poor prognosis groups. Ejection fractions were lower in the poor prognosis group (p = 0.034). Patients with atrial fibrillation as comorbidity were more common in the good prognosis group than poor prognosis group (%35 and %19, p <0.032). New York Heart Association functional classification scores of the patients in the poor prognosis group were higher (p <0.001). The need for oxygen support was higher in the poor prognosis group (p <0.001). In the good prognosis group, there were 29 (59%) discharged patients and 20 (41%) hospitalized patients. In the poor prognosis group, there were 10 (11%) discharged patients, 17 (19%) patients who were hospitalized to cardiology department, 62 (67%) hospitalized to intensive care, and 3 (3%) patients who ended up with death. Conclusion: According to the results of our study, the prognosis of patients with high NEWS and NEWS-L scores were found to be poorer in patients admitted to the emergency department with a decompensated heart failure clinic. Patients with a low NEWS-L score were also found to have a higher rate in the good prognosis group. The NEWS-L score is slightly more successful in predicting prognosis than the NEWS score, but has lower specificity. According to the results of our study, the NEWS-L score is promising to be used as a prognostic indicator in patients with decompensated heart failure presenting to the emergency department. Keywords: decompensated heart failure, National Early Warning Score – Laktat score, NEWS-L score, emergency department, lactate, NEWS