Journal Article

Prognostic Value of the National Early Warning Score Combined with Nutritional and Endothelial Stress Indices for Mortality Prediction in Critically Ill Patients with Pneumonia

Daş, Murat, Kurtkulağı, Özge, Mutlay, Feyza, Beyazıt, Yavuz, Demirer Aydemir, Ferhan, Çetin, Ece Ünal

2026

Overview

Background and Objectives: Pneumonia is a leading cause of intensive care unit (ICU) admission and is associated with high mortality, particularly among patients with multiple comorbidities. Accurate early risk stratification is essential for guiding clinical decision-making in critically ill patients. However, the prognostic benefit of combining clinical scoring systems with nutritional and endothelial stress indices in ICU patients with pneumonia remains unclear. Materials and Methods: This retrospective, single-center cohort study included adult patients admitted to the ICU with a diagnosis of pneumonia between 1 January 2023 and 1 July 2025. Demographic characteristics, comorbidities, clinical variables, laboratory parameters, and prognostic scores were obtained from electronic medical records. The National Early Warning Score (NEWS), Prognostic Nutritional Index (PNI), and Endothelial Activation and Stress Index (EASIX) were calculated at ICU admission. The primary outcome was in-hospital mortality. Univariate and multivariate logistic regression analyses were performed to examine variables associated with in-hospital mortality. The discriminative performance of individual and combined prognostic models was evaluated using receiver operating characteristic (ROC) curve analysis. Results: A total of 221 patients were included; 79 (35.7%) survived and 142 (64.3%) died during hospitalization. Non-survivors had significantly higher NEWS and EASIX values and lower PNI values compared with survivors (all p < 0.05). In multivariate analysis, endotracheal intubation (OR: 12.46; p < 0.001), inotropic use (OR: 5.14; p = 0.001), and serum lactate levels (OR: 1.75; p = 0.003) were identified as being independently associated with in-hospital mortality. Models combining NEWS with PNI or EASIX demonstrated improved discriminatory performance. Conclusions: In critically ill patients with pneumonia, integrating NEWS with nutritional and endothelial stress indices provides numerically improved discrimination compared with NEWS alone, although the incremental gain did not reach statistical significance.

• Publisher: MDPI AG,Multidisciplinary Digital Publishing Institute (MDPI)
• Subject: Aged / Bacterial pneumonia / biomarkers / Blood platelets / C-reactive protein / Cohort Studies / Comorbidity / Creatinine / Critical Illness - mortality / Decision making / Dehydrogenases / Early Warning Score / Electronic health records / Endothelium / Female / Hospital Mortality / Hospital patients / Hospitals / Humans / Information systems / Intensive care / intensive care unit / Intensive Care Units - organization & administration / Intensive Care Units - statistics & numerical data / Intubation / Laboratories / Lymphocytes / Male / Medical records / Medical research / Medicine, Experimental / Middle Aged / Mortality / Nutrition Assessment / Patient outcomes / Physiology / Pneumonia / Pneumonia - mortality / Primary care / Prognosis / Regression analysis / Retrospective Studies / ROC Curve / Taiwan / Turkey / Vital signs