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

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

doi:10.1016/j.rmed.2023.107220

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

Respir Med. 2023 Jun:212:107220. doi: 10.1016/j.rmed.2023.107220. Epub 2023 Mar 29.

Authors

Rachel L Williams¹, Catherine Hyams², Joe Robertshaw³, Maria Garcia Gonzalez⁴, Zsuzsa Szasz-Benczur⁵, Paul White⁶, Nick A Maskell⁷, Adam Finn⁵, Shaney L Barratt⁸; AvonCAP Research Group

Collaborators

AvonCAP Research Group:
David Adegbite⁹, Rupert Antico⁹, Francesca Bayley⁹, Beth Begier¹⁰, Maddalena Bellavia¹¹, Emma Bridgeman⁹, Julia Brzezinska¹², James Campling¹⁰, Natalie Chang¹², Julie Cloake¹², Madeleine Clout⁹, Pip Croxford¹¹, Gillian Ellsbury¹³, Bradford Gessner¹⁰, Niall Grace⁹, Sharon Gray¹⁰, Oliver Griffiths¹², Charli Grimes¹¹, Lucy Grimwood⁹, Zsolt Friedrich¹¹, Leah Fleming⁹, Kazminder Fox¹², Milo Jeenes-Flanagan⁹, Luis Jodar¹⁰, Johanna Kellett Wright¹², Jane Kinney⁹, Robyn Heath¹², Kate Helliker¹¹, Robyn Huber¹⁰, Amelia Langdon⁹, Rajeka Lazarus¹², Sandi Nammuni Arachchge¹², Vicki Mackay¹², Robin Marlow⁹, Zandile Maseko¹¹, Anya Mattocks⁹, Katie Maughan¹², Nicola Manning¹², Katarina Milutinovic¹², Konstantina Minou¹², Anna Morley¹¹, Taslima Mona¹², Claire Mitchell¹², Leigh Morrison¹¹, Bethany Osborne¹², Fiona Perkins¹², Tawassal Riaz¹², Gabriella Ruffino¹¹, Peter Sequenza⁹, Lily Smart⁹, Emma Scott¹², Jo Southern¹³, Seevakumar Suppiah¹¹, Zoe Taylor⁹, Grace Tilzey¹², Anabella Turner¹², Gabriella Valentine⁹, Marianne Vasquez¹¹, Rhian Walters¹², Lana Ward¹¹, Louise Wright¹¹

Affiliations

¹ Academic Respiratory Unit, University of Bristol, North Bristol NHS Trust, Southmead, Bristol, BS10 5NB, UK; Research and Innovation, North Bristol NHS Trust, Southmead, Bristol, BS10 5NB, UK.
² Academic Respiratory Unit, University of Bristol, North Bristol NHS Trust, Southmead, Bristol, BS10 5NB, UK; Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Southmead, Bristol, BS10 5NB, UK; Bristol Vaccine Centre, Schools of Population Health Sciences and Cellular and Molecular Medicine, University of Bristol, Bristol, BS2 8AE, UK; Vaccine and Testing Team, UHBW NHS Trust, Bristol, UK.
³ Academic Respiratory Unit, University of Bristol, North Bristol NHS Trust, Southmead, Bristol, BS10 5NB, UK; Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Southmead, Bristol, BS10 5NB, UK.
⁴ Bristol Vaccine Centre, Schools of Population Health Sciences and Cellular and Molecular Medicine, University of Bristol, Bristol, BS2 8AE, UK; Vaccine and Testing Team, UHBW NHS Trust, Bristol, UK.
⁵ Bristol Vaccine Centre, Schools of Population Health Sciences and Cellular and Molecular Medicine, University of Bristol, Bristol, BS2 8AE, UK.
⁶ University of the West of England, Bristol, BS16 1QY, UK.
⁷ Academic Respiratory Unit, University of Bristol, North Bristol NHS Trust, Southmead, Bristol, BS10 5NB, UK.
⁸ Academic Respiratory Unit, University of Bristol, North Bristol NHS Trust, Southmead, Bristol, BS10 5NB, UK; Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Southmead, Bristol, BS10 5NB, UK. Electronic address: shaney.barratt@nbt.nhs.uk.
⁹ Bristol Vaccine Centre, University of Bristol, UK.
¹⁰ Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, USA.
¹¹ North Bristol NHS Trust, UK.
¹² Clinical Research and Imaging Centre, UHBW NHS Trust, UK.
¹³ Vaccines Medical Development, Scientific & Clinical Affairs, Pfizer Inc, UK.

PMID: 36997098
DOI: 10.1016/j.rmed.2023.107220

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.

Keywords: Acute respiratory deterioration; Interstitial lung disease; Pulmonary fibrosis; Severity scores.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Hospital Mortality
Humans
Lung Diseases, Interstitial*
Patient Acuity
Prognosis
Prospective Studies
ROC Curve
Retrospective Studies
Severity of Illness Index