The use of scoring systems and lactate in the estimation of short-term mortality in patients over 65 years of age presenting to the emergency department with dyspnea

In this study, it was aimed to investigate the usability of risk scoring systems and the combined forms calculated by adding "lactate" value to these in terms of short-term mortality estimation in patients over 65 years of age who applied to the emergency department with the complaint of non-traumatic dyspnea. The population of the study consisted of adult patients aged 65 and over who applied to Bursa Uludağ University Faculty of Medicine Emergency Department (ED) with complaints of dyspnea between January 1, 2019 and December 31, 2019 (n = 769). Admission MEWS, NEWS, REMS, VIEWS scores and their combined forms with added lactate and 7, 14 and 28 days survival were recorded. 59.6% of the cases were male, the mean age was 75.6 ± 7.4 years. According to the MEWS score, 24.2% of the cases, 4.9% according to the REMS score, 45.3% according to the VIEWS score, and 33% according to the NEWS score were in the high/very high risk group. It was determined that 42.9% of the cases were discharged, 34.1% were hospitalized, and 1.6% died in the ED. It was found that 11.2% of the cases died in the first seven days, 16.1% in the first 14 days, and 23% in the first 28 days. The mortality frequency of patients with cardiopulmonary disease, neurological disease, malignancy, needing oxygen support, hospitalized/referred to the intensive care unit, hospitalized to the cardiology department, unresponsive to stimuli according to Alet, Verbal, Pain Unresponsive (AVPU) and patients with high risk according to other clinical risk scores were statistically significantly higher (p<0.05). Compared to the survivors, the age, heart rate, respiratory rate, lactate level, and clinical scores (excluding GCS) of the deceased subjects were statistically significantly higher, blood pressure, SpO2 level, and GCS score were lower (p<0.001). It was observed that all scores and lactate value could predict the 28-day mortality at a certain cut-off point statistically significantly (p<0.001). It was determined that the 28-day mortality was best predicted by the NEWS-L score at 8.945 cut-off points with 65% sensitivity and 77.2% specificity (p<0.001). In cases with dyspnea, lactate value, REMS, MEWS, VIEWS, NEWS, REMS-L, MEWS-L, VIEWS-L, NEWS-L scores can be used to predict early mortality; Risk scores modified with lactate value were found to be more successful in predicting 28-day mortality.