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

## TL;DR

This study explores how combining a clinical score with nutritional and endothelial stress indicators can better predict mortality in ICU patients with pneumonia.

## Contribution

The study introduces a novel approach by integrating the National Early Warning Score with nutritional and endothelial stress indices for mortality prediction in pneumonia patients.

## Key findings

- Non-survivors had significantly higher NEWS and EASIX values and lower PNI values compared with survivors.
- Models combining NEWS with PNI or EASIX showed improved discriminatory performance for predicting mortality.
- Endotracheal intubation, inotropic use, and serum lactate levels were independently associated with in-hospital mortality.

## Abstract

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.