The Mortality in Emergency Department Sepsis Score as a Predictor of 1-Month Mortality among Adult Patients with Sepsis: Weighing the Evidence

Objective. To evaluate the performance of Mortality in Emergency Department Sepsis (MEDS) score in comparison to biomarkers as a predictor of mortality in adult emergency department (ED) patients with sepsis. Methods. A literature search was performed using PubMed, ScienceDirect, SpringerLink, and Ovid databases. Studies were appraised by using the C2010 Consensus Process for Levels of Evidence for prognostic studies. The respective values for area under the curve (AUC) were obtained from the selected articles. Results. Four relevant articles met the selection process. Three studies defined the 1-month mortality as death occurring within 28 days of ED presentation, while the remaining one subcategorised the outcome measure as (5-day) early and (6- to 30-day) late mortality. In all four studies, the MEDS score performed better than the respective comparators (C-reactive protein, lactate, procalcitonin, and interleukin-6) in predicting mortality with an AUC ranging from 0.78 to 0.89 across the studies. Conclusion. The MEDS score has a better prognostic value than the respective comparators in predicting 1-month mortality in adult ED patients with suspected sepsis.

Download Full-text

Procalcitonin is a Better Biomarker than C-Reactive Protein in Newborns Undergoing Cardiac Surgery: The Prokineca Study

Biomarker Insights ◽

10.4137/bmi.s40658 ◽

2016 ◽

Vol 11 ◽

pp. BMI.S40658 ◽

Cited By ~ 1

Author(s):

Sara Bobillo Pérez ◽

Javier Rodríguez-Fanjul ◽

Iolanda Jordan García ◽

Julio Moreno Hernando ◽

Martín Iriondo Sanz

Keyword(s):

Cardiopulmonary Bypass ◽

Neonatal Intensive Care ◽

Area Under The Curve ◽

C Reactive Protein ◽

Sepsis Diagnosis ◽

Reactive Protein ◽

Optimal Area ◽

A Prospective Study ◽

Kinetics Of ◽

Better Than

Objectives To assess the kinetics of procalcitonin (PCT) and C-reactive protein (CRP) in newborns after cardiothoracic surgery (CS), with and without cardiopulmonary bypass, and to assess whether PCT was better than CRP in identifying sepsis in the first 72 hours after CS. Patients and Methods This is a prospective study of newborns admitted to the neonatal intensive care unit after CS. Interventions PCT and CRP were sequentially drawn 2 hours before surgery and at 0, 12, 24, 48, and 72 hours after surgery. Results A total of 65 patients were recruited, of which 14 were excluded because of complications. We compared the kinetics of PCT and CRP after CS in bypass and non-bypass groups without sepsis; there were no differences in the PCT values at any time (24 hours, P = 0.564; 48 hours, P = 0.117; 72 hours, P = 0.076). Thirty-five patients needed bypass, of whom four were septic (11.4%). Significant differences were detected in the PCT values on comparing the septic group to the nonseptic group at 48 hours after cardiopulmonary bypass ( P= 0.018). No differences were detected in the CRP values in these groups. A suitable cutoff for sepsis diagnosis at 48 hours following bypass would be 5 ng/mL, with optimal area under the curve of 0.867 (confidence interval 0.709–0.958), P< 0.0001, and sensitivity and specificity of 87.5% (29.6–99.7) and 72.6% (53.5–86.4), respectively. Conclusions This is a preliminary study but PCT seems to be a good biomarker in newborns after CS. Values over 5 ng/mL at 48 hours after CS should alert physicians to the high risk of sepsis in these patients.

Download Full-text

COMPARISON OF PRESEPSIN, PROCALCITONIN, INTERLEUKIN-8 AND C-REACTIVE PROTEIN IN PREDICTING BACTERAEMIA IN FEBRILE NEUTROPENIC ADULT PATIENTS WITH HAEMATOLOGICAL MALIGNANCIES

Mediterranean Journal of Hematology and Infectious Diseases ◽

10.4084/mjhid.2019.047 ◽

2019 ◽

Vol 11 (1) ◽

pp. e2019047 ◽

Cited By ~ 2

Author(s):

Irena Kostic ◽

Carmela Gurrieri ◽

Elisa Piva ◽

Gianpietro Semenzato ◽

Mario Plebani ◽

...

Keyword(s):

Febrile Neutropenia ◽

Bacterial Infections ◽

Area Under The Curve ◽

Interleukin 8 ◽

Adult Patients ◽

Haematological Malignancies ◽

C Reactive Protein ◽

Reactive Protein ◽

Life Threatening ◽

Better Than

Bacterial infections represent life-threatening complications in patients with febrile neutropenia (FN). Biomarkers of infections may help to differentiate bacteraemia from non-bacteraemia FN. We aimed to evaluate the utility of procalcitonin (PCT), presepsin (PS), C-reactive protein (CRP) and interleukin-8 (IL-8) as biomarkers of bacteraemia in adult FN patients with haematological malignancies. Thirty-six FN episodes experienced by 28 oncohematological patients were considered. 11 out of 36 episodes were classified as bacteraemia. PCT was the best biomarker to predict bacteraemia with area under the curve (AUC) ROC of 0,9; while the most sensitive was IL-8 (90,9%) with AUC ROC of 0,88. All patients with PCT concentrations above 1,6 μg/l had bacteraemia. Patients with IL-8 concentrations > 170 pg/ml or PS concentrations superior then 410 pg/ml had 40 times and 24 times higher risk for bacteraemia, respectively. PCT remains better than IL-8 and PS in predicting bacteraemia in adult hematological patients with FN.

Download Full-text

Differentiation between myopericarditis and acute myocardial infarction on presentation in the emergency department using the admission C-reactive protein to troponin ratio

PLoS ONE ◽

10.1371/journal.pone.0248365 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0248365

Author(s):

Simcha R. Meisel ◽

Hamuda Nashed ◽

Randa Natour ◽

Rami Abu Fanne ◽

Majdi Saada ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Emergency Department ◽

Roc Analysis ◽

Area Under The Curve ◽

C Reactive Protein ◽

Reactive Protein ◽

St Elevation ◽

Operator Curve ◽

Median Admission

Background The treatment of myopericarditis is different than that of acute myocardial infarction (AMI). However, since their clinical presentation is frequently similar it may be difficult to distinguish between these entities despite a disparate underlying pathogenesis. Myopericarditis is primarily an inflammatory disease associated with high C-reactive protein (CRP) and relatively low elevated troponin concentrations, while AMI is characterized by the opposite. We hypothesized that evaluation of the CRP/troponin ratio on presentation to the emergency department could improve the differentiation between these two related clinical entities whose therapy is different. Such differentiation should facilitate triage to appropriate and expeditious therapy. Methods We evaluated the CRP/troponin ratio on presentation among patients consecutively included in a large single center registry that included 1898 consecutive patients comprising 1025 ST-elevation myocardial infarction (STEMI) patients, 518 Non-STEMI (NSTEMI) patients, and 355 patients diagnosed on discharge as myopericarditis. CRP and troponin were sampled on admission in all patients and their ratio was assessed against discharge diagnosis. ROC analysis of the CRP/troponin ratios evaluated the diagnostic accuracy of myopericarditis against all AMI, STEMI, and NSTEMI patients. Results Median admission CRP/troponin ratios were 84, 65, and 436 mg×ml/liter×ng in STEMI, NSTEMI and myopericarditis groups, respectively (p<0.001) demonstrating good differentiating capability. The Receiver-operator-curve of admission CRP/troponin ratio for diagnosis of myopericarditis against all AMI, STEMI, and NSTEMI patients yielded an area-under-the curve of 0.74, 0.73, and 0.765, respectively. CRP/troponin ratio>500 resulted in specificity exceeding 85%, and for a ratio>1000, specificity>92%. Conclusion The CRP/troponin ratio can serve as an effective tool to differentiate between myopericarditis and AMI. In the appropriate clinical context, the CRP/troponin ratio may preclude further evaluation.

Download Full-text

Diagnostic accuracy of three biomarkers in identifying serious bacterial infections in children younger than 36 months with fever without source / Acurateţea diagnostică a trei biomarkeri în identificarea infecţiilor bacteriene severe la copiii cu vârsta sub 36 luni cu febră fără focar

Revista Romana de Medicina de Laborator ◽

10.1515/rrlm-2015-0032 ◽

2015 ◽

Vol 23 (3) ◽

pp. 313-322

Author(s):

Diana Aniela Moldovan ◽

Maria Despina Baghiu ◽

Alina Balas ◽

Emese Rozalia Fabian-Frast ◽

Cristian Boeriu

Keyword(s):

Emergency Department ◽

Diagnostic Accuracy ◽

Interleukin 6 ◽

Bacterial Infections ◽

Screening Tool ◽

University Hospital ◽

C Reactive Protein ◽

Reactive Protein ◽

Serious Bacterial Infections ◽

Better Than

Abstract Objectives: Our study aimed to evaluate and compare the accuracy of C-reactive protein, Procalcitonin and Interleukine-6 in identifying serious bacterial infections (SBI) in children with fever without source. Methods: 139 children, aged 7 days to 36 months, addressing the Emergency Department from a Romanian university hospital, were prospectively enrolled during 2013. C-reactive protein, Procalcitonin and Interleukin-6 were determined for every patient. SBI diagnosis was based on cultures results and chest radiographs. Results: 31 patients (22.3%) had SBI. C-reactive protein [AUC: 0.87 (95%CI: 0.81-0.92)] and Procalcitonin [AUC: 0.83 (95%CI: 0.76-0.89)] proved strong prediction value for SBI and performed better than Interleukin-6 [AUC: 0.77 (95%CI: 0.69-0.84)]. For the group of children with the duration of fever less than 8 hours, Interleukin- 6 was the best predictor [AUC: 0.88 (0.76-0.95)]. Conclusions: Both C-reactive protein and Procalcitonin are strong and similar predictors for SBI, and Interleukin- 6 might be a better SBI screening tool for children with shorter duration of fever.

Download Full-text

Novel Protein Markers of Acute Coronary Syndrome Complications in Low-Risk Outpatients: A Systematic Review of Potential Use in the Emergency Department

Clinical Chemistry ◽

10.1373/clinchem.2005.052456 ◽

2005 ◽

Vol 51 (11) ◽

pp. 2005-2012 ◽

Cited By ~ 12

Author(s):

Alice M Mitchell ◽

Michael D Brown ◽

Ian BA Menown ◽

Jeffery A Kline

Keyword(s):

Emergency Department ◽

Area Under The Curve ◽

Negative Likelihood Ratio ◽

Low Risk ◽

Protein Markers ◽

C Reactive Protein ◽

Reactive Protein ◽

Coronary Syndrome ◽

Published Evidence ◽

New Protein

Abstract Background: Published literature was systematically reviewed to determine the diagnostic accuracy of new protein markers of acute coronary syndromes (ACS) in symptomatic outpatients at low risk of ACS and related complications comparable to patients evaluated in emergency department chest pain units. Methods: Studies were identified by a MEDLINE® (1966 to May week 3, 2005) search. Abstracts were reviewed for relevance, and manuscripts were included by the independent consensus of 2 observers based on explicit criteria restricting the analysis to studies relevant to screening ambulatory patients with symptoms suggesting ACS. Publication bias was identified by a modified funnel plot analysis [study size (y) vs the inverse of the negative likelihood ratio (x)]. Results of individual markers were reported separately. When 3 or more eligible studies were identified, data were aggregated by use of the summary ROC (SROC) curve. Results: Twenty-two protein markers in 10 unique populations met the inclusion criteria. Data required for SROC analysis (true- and false-positive rates) were available for 17 markers, in 9 unique populations, from publications and personal communications. Of these, only C-reactive protein was published in more than 2 populations to allow aggregation (6 studies total). C-Reactive protein demonstrated poor diagnostic performance on SROC curve analysis, with an area under the curve of 0.61 and a pooled diagnostic odds ratio of 1.81 (95% confidence interval, 1.06–3.07). Conclusion: Published evidence is not sufficient to support the routine use of new protein markers in screening for ACS in the emergency department setting.

Download Full-text

PROGNOSTIC VALUE OF MORTALITY IN EMERGENCY DEPARTMENT SEPSIS SCORE, PROCALCITONIN, AND C-REACTIVE PROTEIN IN PATIENTS WITH SEPSIS AT THE EMERGENCY DEPARTMENT

Shock ◽

10.1097/shk.0b013e31815077ca ◽

2007 ◽

pp. 1 ◽

Cited By ~ 6

Author(s):

Chien-Chang Lee ◽

Shey-Ying Chen ◽

Chu-Lin Tsai ◽

Shwu-Chong Wu ◽

Wen-Chu Chiang ◽

...

Keyword(s):

Emergency Department ◽

Prognostic Value ◽

C Reactive Protein ◽

Reactive Protein ◽

Sepsis Score

Download Full-text

C-Reactive Protein to Determine the Duration of Antibiotic Therapy in Infants With Suspected Sepsis

PEDIATRICS ◽

10.1542/peds.100.5.900 ◽

1997 ◽

Vol 100 (5) ◽

pp. 900-900 ◽

Cited By ~ 3

Author(s):

M. J. Grella; ◽

S. Ehl ◽

F. Pohlandt

Keyword(s):

Antibiotic Therapy ◽

C Reactive Protein ◽

Suspected Sepsis ◽

Reactive Protein

Download Full-text

Diagnostic Value of C-Reactive Protein in Discrimination between Uncomplicated and Complicated Parapneumonic Effusion

Diagnostics ◽

10.3390/diagnostics10100829 ◽

2020 ◽

Vol 10 (10) ◽

pp. 829

Author(s):

Yana Kogan ◽

Edmond Sabo ◽

Majed Odeh

Keyword(s):

Area Under The Curve ◽

Diagnostic Value ◽

Parapneumonic Effusion ◽

C Reactive Protein ◽

Diagnostic Efficacy ◽

Reactive Protein ◽

Significant Difference ◽

Study Population ◽

Complicated Parapneumonic Effusion

Objectives: The role of serum C-reactive protein (CRPs) and pleural fluid CRP (CRPpf) in discriminating uncomplicated parapneumonic effusion (UCPPE) from complicated parapneumonic effusion (CPPE) is yet to be validated since most of the previous studies were on small cohorts and with variable results. The role of CRPs and CRPpf gradient (CRPg) and of their ratio (CRPr) in this discrimination has not been previously reported. The study aims to assess the diagnostic efficacy of CRPs, CRPpf, CRPr, and CRPg in discriminating UCPPE from CPPE in a relatively large cohort. Methods: The study population included 146 patients with PPE, 86 with UCPPE and 60 with CPPE. Levels of CRPs and CRPpf were measured, and the CRPg and CRPr were calculated. The values are presented as mean ± SD. Results: Mean levels of CRPs, CRPpf, CRPg, and CRPr of the UCPPE group were 145.3 ± 67.6 mg/L, 58.5 ± 38.5 mg/L, 86.8 ± 37.3 mg/L, and 0.39 ± 0.11, respectively, and for the CPPE group were 302.2 ± 75.6 mg/L, 112 ± 65 mg/L, 188.3 ± 62.3 mg/L, and 0.36 ± 0.19, respectively. Levels of CRPs, CRPpf, and CRPg were significantly higher in the CPPE than in the UCPPE group (p < 0.0001). No significant difference was found between the two groups for levels of CRPr (p = 0.26). The best cut-off value calculated by the receiver operating characteristic (ROC) analysis for discriminating UCPPE from CPPE was for CRPs, 211.5 mg/L with area under the curve (AUC) = 94% and p < 0.0001, for CRPpf, 90.5 mg/L with AUC = 76.3% and p < 0.0001, and for CRPg, 142 mg/L with AUC = 91% and p < 0.0001. Conclusions: CRPs, CRPpf, and CRPg are strong markers for discrimination between UCPPE and CPPE, while CRPr has no role in this discrimination.

Download Full-text