The combination of scoring systems and lactate for predicting short-term mortality in geriatric patients with dyspnea

Background Dyspnea is one of the most common causes for admission to the emergency department. Lactate (L), which can be used as a prognostic marker, was first studied by Broder and Weil and it was shown that a level > 4 mmol/l is associated with a poor prognosis. There are also scoring systems to assess the severity of illness of patients presenting to the emergency department such as the National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS) and VitalPAC Early Warning Score (ViEWS). Objectives In this study, we aimed to investigate the combination of risk scoring systems and lactate in predicting short-term mortality in patients over 65 years of age with the complaint of nontraumatic dyspnea. Materials and methods The population of the study consisted of adult patients aged 65 and over who presented to Bursa Uludag University Medical Faculty Emergency Department with dyspnea. Admission NEWS, MEWS, REMS, ViEWS scores and their combined forms with added lactate levels at first admission, and 7‑, 14-, and 28-day survival were recorded. Results We found that the modified composite scores with lactate value, and the NEWS, MEWS, REMS, and ViEWS scores could predict the 28-day mortality. Ranking the scores and lactate value predicting 28-day mortality according to the area under the curve (AUC) value revealed that the 28-day mortality was best predicted by the NEWS + lactate with 64.97% sensitivity and 77.53% specificity ( p < 0.001). We have shown that increasing lactate levels, NEWS, MEWS, REMS, ViEWS scores and their modified composite scores with lactate above suggested thresholds are independent risk factors for increased mortality in multivariable Cox regression analysis. Conclusions In cases with dyspnea, lactate value, NEWS, MEWS, REMS, ViEWS, NEWS‑L MEWS‑L, REMS‑L, and ViEWS‑L scores can be used to predict early mortality. Risk scores modified with lactate value were found to be more successful in predicting 28-day mortality.