Key result
Elevated NEWS2 score is linked to ~2.1-fold higher long-term mortality in hospitalized acute dyspnea.
Why the study?
ESC guidelines recommend no risk stratification system for patients hospitalised with acute dyspnoea due to AHF, and the prognostic value of combining NEWS2 with cardiac biomarkers is unknown.
Does an elevated NEWS2 score predict long-term mortality in patients hospitalized with acute dyspnoea?
Cohort (n=314)
No
Does an elevated NEWS2 score predict long-term mortality in patients hospitalized with acute dyspnoea?
NEWS2 is an accessible clinical tool that independently predicts long-term mortality in patients presenting with acute dyspnoea and provides incremental value over cardiac biomarkers.
May aid long-term risk stratification in acute dyspnoea beyond biomarkers; hypothesis-generating, requiring prospective validation before practice change.
OBJECTIVE: Patients hospitalised with acute dyspnoea due to acute heart failure (AHF) have a grave prognosis, but the European Society of Cardiology guidelines recommend no system to risk stratify these patients. The prognostic value of combining National Early Warning Score (NEWS) 2 and established cardiac biomarkers is not known. METHODS: We measured high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and calculated NEWS2 in 314 patients with acute dyspnoea within 24 hours of hospitalisation. Their prognostic merits were assessed in the total cohort and for the subgroup with AHF separately. RESULTS: The median age was 73 (quartile (Q) 1-3, 63-81) years, 48% were women and 143 patients (46%) were hospitalised with AHF. The 114 patients (36%) who died during follow-up (median 823 days, Q1-3, 471-998) had higher concentrations of hs-cTnT (62 vs 33 ng/L, p<0.001) and NT-proBNP (6995 vs 2605 ng/L, p<0.001), and higher NEWS2 (6.1 vs 4.5 points, p<0.001), compared with survivors. Patients with increased vs low NEWS2 clinical risk had higher mortality rates in adjusted analyses in the total cohort (HR 2.11, 95% CI 1.28 to 3.48) and in patients with AHF (HR 2.00, 95% CI 1.54 to 2.60). NEWS2 provided incremental prognostic information compared with biomarkers alone for the total cohort: area under the curve 0.72 vs 0.70, p=0.042, and for the subpopulation with AHF: 0.70 vs 0.67, p=0.014. CONCLUSION: NEWS2 predicts long-term mortality in patients hospitalised due to acute dyspnoea and the subgroup with AHF and provide incremental prognostic information to hs-cTnT and NT-proBNP.
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Berge et al. (2022) conducted a cohort in Acute dyspnoea (n=314). Elevated National Early Warning Score 2 (NEWS2) vs. Low NEWS2 clinical risk was evaluated on Long-term all-cause mortality (HR 2.11, 95% CI 1.28-3.48, p=0.034). Increased NEWS2 clinical risk was associated with higher long-term mortality (HR 2.11) compared to low risk in patients hospitalized with acute dyspnoea.
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