Metabolic Augmentation of mREMS: Improved 30-day Mortality Prediction through Lactate and Base Excess Integration in Emergency Patients

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MERAL G., Gunay S., ÖZEL R., KÖSE A.

Eurasian Journal of Emergency Medicine, sa.25, ss.175-185, 2026 (ESCI, TRDizin)

Özet

Aim: To evaluate whether adding base excess (BE), alone or in combination with lactate, to the modified Rapid Emergency Medicine score (mREMS) improves 30-day mortality prediction in emergency department (ED) red-zone patients. Materials and Methods: This observational cohort study included eligible ED red-zone patients presenting between May 2018 and December 2019 (n=1798). Vital signs, Glasgow Coma scale (GCS) scores, and blood gas parameters were collected. Because the relationship between BE and 30-day mortality was non-linear, BE was categorized using a data-driven, mortality-associated classification approach. The resulting categories were weighted using effect sizes from multivariable logistic regression and converted into an ordinal variable (0-3 points), which was integrated into the mREMS framework. Three models were developed: mREMS-Be, mREMS-L, and mREMS-LBe. Model discrimination was evaluated using the area under the curve (AUC) and comparisons were performed using the DeLong test. Results: Thirty-day mortality was associated with older age, lower systolic blood pressure, lower SpO2, and lower GCS (p<0.05). BE was not predictive when modeled as a continuous variable; however, it demonstrated an independent association with mortality when modeled as an ordinal variable (p=0.022). The AUC of the baseline mREMS was 0.753; it increased to 0.767 with the addition of BE and to 0.782 when BE was combined with lactate. Integration of BE into mREMS resulted in a significant improvement in model discrimination in both the overall and the non-traumatic red-zone patient groups. Conclusion: Incorporating BE into mREMS provides complementary prognostic value by improving 30-day mortality discrimination among high-acuity ED patients.