title: A combination of early warning score and lactate to predict intensive care unit transfer of inpatients with severe sepsis/septic shock.
abstract: OBJECTIVE
  The modified early warning score (MEWS) is used to predict patient intensive care unit (ICU) admission and mortality. Lactate (LA) in the blood lactate (BLA) is measured to evaluate disease severity and treatment efficacy in patients with severe sepsis/septic shock. The usefulness of a combination of MEWS and BLA to predict ICU transfer in severe sepsis/septic shock patients is unclear. We evaluated whether use of a combination of MEWS and BLA enhances prediction of ICU transfer and mortality in hospitalized patients with severe sepsis/septic shock.
  
  
  METHODS
  Patients with severe sepsis/septic shock who were screened or contacted by a medical emergency team between January 2012 and August 2012 were enrolled at a university-affiliated hospital with ~2,700 beds, including 28 medical ICU beds.
  
  
  RESULTS
  One hundred patients were enrolled and the rate of ICU admittance was 38%. MEWS (7.37 vs. 4.85) and BLA concentration (5 mmol/L vs. 2.19 mmol/L) were significantly higher in patients transferred to ICU than those in patients treated in general wards. The combination of MEWS and BLA was more accurate than MEWS alone in terms of ICU transfer (C-statistics: 0.898 vs. 0.816, p = 0.019). The 28-day mortality rate was 19%. MEWS was the only factor significantly associated with 28-day mortality rate (odds ratio, 1.462; 95% confidence interval, 1.122 to 1.905; p = 0.005).
  
  
  CONCLUSIONS
  The combination of MEWS and BLA may enhance prediction of ICU transfer in patients with severe sepsis/septic shock.
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jung-Wan
authors.initials: JW
authors.lastname: Yoo
authors.affiliation: Medical Emergency Team, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Ju Ry
authors.initials: JR
authors.lastname: Lee
authors.affiliation: Medical Emergency Team, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Youn Kyung
authors.initials: YK
authors.lastname: Jung
authors.affiliation: Medical Emergency Team, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Sun Hui
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Medical Emergency Team, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jeong Suk
authors.initials: JS
authors.lastname: Son
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Byung Ju
authors.initials: BJ
authors.lastname: Kang
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Tai Sun
authors.initials: TS
authors.lastname: Park
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jin-Won
authors.initials: JW
authors.lastname: Huh
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Chae-Man
authors.initials: CM
authors.lastname: Lim
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Younsuck
authors.initials: Y
authors.lastname: Koh
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Sang Bum
authors.initials: SB
authors.lastname: Hong
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003661:Decision Support Techniques; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006742:Hospital Bed Capacity; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D012772:Shock, Septic / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D013997:Time Factors
chemical_list: D015415:Biomarkers; D019344:Lactic Acid
keywords: Intensive care units; Lactates; Modified early warning score; Severe sepsis; Shock, septic