Abstract
Background Sepsis is a group of systemic manifestations resulting from an underlying infection that triggers an immune response that causes injury to the host. Chemotherapy-receiving oncology patients (CROPs) are particularly prone to sepsis; however, their suppressed immune system renders the signs of inflammation less evident. The Modified Early Warning Score (MEWS), with a cutoff value of ³4, is a tool intended to detect patients with deteriorating clinical circumstances early and to predict the need for intensive care unit (ICU) transfer. Therefore, we aimed to assess the usefulness of MEWS in predicting ICU admission and mortality in CROPs with positive blood culture.
Methods Electronic records of patients hospitalized in King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia, from June 2016 to June 2017 were retrospectively reviewed. Adults older than 14 years with positive blood cultures were included and subdivided into two groups: CROP cases and immunocompetent controls; comparison was referenced to the actual ICU admittance. MEWS was calculated at different time intervals before, after, and at the time of positive blood culture in both groups to identify its discriminative capability. Receiver operator curves (ROC) analysis was used to determine the best cutoff MEWS at different time intervals.
Results 192 individuals with positive blood culture were included: 89 CROPs and 103 controls. 21% of cases and 50% of controls were admitted to the ICU (p<0.001). The proportion of patients who had positive MEWS of ³4 requiring ICU admission was 34.8% in CROPs compared with 45.6% in controls (p=0.129). The sensitivity, specificity, positive predictive value, and negative predictive value for a positive MEWS of ³4 in CROPs was 52.5%, 70%, 32.3%, and 84%, respectively, and this was comparable with the control group. ROC analysis showed that MEWS was a significant predictor for ICU admission if calculated 12 to 36 hours before positive blood culture in CROPs, and a threshold of ³3 had the best specificity (86–91%) for predicting ICU admission, whereas a threshold of ³4 was more suitable for controls. MEWS was generally a poor predictor for mortality.
Conclusion MEWS in general has weak discriminatory value in predicting ICU admission in CROPs. A threshold of ³3 MEWS at 12 to 36 hours before positive blood culture was found to be the best cutoff for predicting ICU admission in CROPs compared with a threshold of ³4 in controls. MEWS was a poor predictor for mortality within 28 days. The combination of MEWS with clinical judgment might improve prediction for ICU admission.
