title: Modified early warning score with rapid lactate level in critically ill medical patients: the ViEWS-L score.
abstract: OBJECTIVE
  To examine whether the predictive value of the early warning score (EWS) could be improved by including rapid lactate levels, and to compare the modified EWS with the pre-existing risk scoring systems.
  
  
  METHODS
  Retrospective observational study in South Korea.
  
  
  METHODS
  An urban, academic, tertiary hospital.
  
  
  METHODS
  Consecutive adult patients who were admitted to the medical intensive care unit via the emergency department (ED).
  
  
  METHODS
  A newly developed EWS--the VitalPAC EWS (ViEWS), was used in the present study. Lactate level, ViEWS and HOTEL score were obtained from patients at presentation to the ED, and APACHE II, SAPS II and SAPS III scores were obtained after admission. The area under curve of each risk scoring system for in-hospital, 1-week, 2-week and 4-week mortality was compared.
  
  
  RESULTS
  151 patients were enrolled and the mortality was 42.4%. The ViEWS-L score was calculated as follows: ViEWS-L score=ViEWS+lactate (mmol/l) according to the regression coefficient. The mean ViEWS-L score was 11.6±7.3. The ViEWS-L score had a better predictive value than the ViEWS score for hospital mortality (0.802 vs 0.742, p=0.009), 1-week mortality (0.842 vs 0.707, p<0.001), 2-week mortality (0.827 vs 0.729, p<0.001) and 4-week mortality (0.803 vs 0.732, p=0.003). The ViEWS-L score also had a better predictive value than the HOTEL and APACHE II scores. The predictive value of ViEWS-L was comparable with SAPS II and SAPS III.
  
  
  CONCLUSIONS
  The ViEWS-L score performed as well as or better than the pre-existing risk scoring systems in predicting mortality in critically ill medical patients who were admitted to the medical intensive care unit via the ED.
authors.affiliation: Department of Emergency Medicine, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Jeonju, Korea.
authors.forename: Sion
authors.initials: S
authors.lastname: Jo
authors.forename: Jae Baek
authors.initials: JB
authors.lastname: Lee
authors.forename: Young Ho
authors.initials: YH
authors.lastname: Jin
authors.forename: Tae Oh
authors.initials: TO
authors.lastname: Jeong
authors.forename: Jae Chol
authors.initials: JC
authors.lastname: Yoon
authors.forename: Yong Kyu
authors.initials: YK
authors.lastname: Jun
authors.forename: Bo Young
authors.initials: BY
authors.lastname: Park
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007773:Lactates / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012044:Regression Analysis; D056910:Republic of Korea; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D007773:Lactates