title: Combined use of the National Early Warning Score and D-dimer levels to predict 30-day and 365-day mortality in medical patients.
abstract: To investigate the combined use of NEWS and D-dimer levels to predict the 30-day and 365-day mortality rates of a cohort of Danish patients with complete follow-up.
  
  
  
  Post-hoc retrospective observational study of acutely admitted medical patients aged 18 years or older who had D-dimer measured within 6h after arrival to two medical admission units in Denmark.
  
  
  
  The final study population consisted of 1201 patients with a median age of 65.0 years (range 18.0-107.0 years), and 44.7% were of male sex. Four patients (0.3%) died within 24h of admission, 69 (5.7%) within 30 days and 198 (16.5%) within 365 days. On admission, 576 (48%) patients had a NEWS≥3 - of these 441 had a D-dimer≥0.50mgL(-1): 55 (12.5%) of these patients died within 30 days, compared with 5 (3.7%) of the 135 patients with a D-dimer<0.50mgL(-1) (odds ratio 3.7, 95%CI 1.4-10.8). Nine of the 625 patients with a NEWS on admission <3 died within 30 days and all of these patients had a D-dimer≥0.50mgL(-1). None of the 218 patients with a D-dimer<0.50mgL(-1) died within 30 days of admission.
  
  
  
  The combination of NEWS score<3 and D-dimer levels below 0.50mgL(-1) appears to identify patients of low risk of mortality within 30 days and, therefore, may prove to be a powerful risk assessment tool for acutely ill medical patients.
authors.affiliation: Emergency Department, University Hospital Basel, Switzerland. Electronic address: christian.nickel@usb.ch.
authors.forename: Christian H
authors.initials: CH
authors.lastname: Nickel
authors.affiliation: Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark.
authors.forename: John
authors.initials: J
authors.lastname: Kellett
authors.affiliation: Department of Acute Medicine, University Hospital of South Manchester, United Kingdom.
authors.forename: Tim
authors.initials: T
authors.lastname: Cooksley
authors.affiliation: Emergency Department, University Hospital Basel, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: Bingisser
authors.affiliation: Department of Emergency Medicine, Odense University Hospital, Denmark.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Henriksen
authors.affiliation: Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark; Department of Emergency Medicine, Odense University Hospital, Denmark.
authors.forename: Mikkel
authors.initials: M
authors.lastname: Brabrand
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: D-dimer; Early warning scores; Emergency department; Mortality; Risk stratification; predictive scores