scholarly journals Role of presepsin for the evaluation of sepsis in the emergency department

2014 ◽  
Vol 0 (0) ◽  
Author(s):  
Elisa Pizzolato ◽  
Marco Ulla ◽  
Claudia Galluzzo ◽  
Manuela Lucchiari ◽  
Tilde Manetta ◽  
...  
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Early Diagnosis ◽  
Bacterial Infections ◽  
Acute Phase Proteins ◽  
Great Sensitivity ◽  
Healthy Population ◽  
Suspected Sepsis ◽  
Gold Standard Method ◽  
Suspected Infection

AbstractSepsis, severe sepsis and septic shock are among the most common conditions handled in the emergency department (ED). According to new Sepsis Guidelines, early diagnosis and treatment are the keys to improve survival. Plasma C-reactive protein (CRP) and procalcitonin (PCT) levels, when associated with documented or suspected infection, are now part of the definitions of sepsis. Blood culture is the gold standard method for detecting microorganisms but it requires too much time for results to be known. Sensitive biomarkers are required for early diagnosis and as indexes of prognosis sepsis. CRP is one of the acute phase proteins synthesized by the liver: it has a great sensitivity but a very poor specificity for bacterial infections. Moreover, the evolution of sepsis does not correlate with CRP plasma changes. In recent years PCT has been widely used for sepsis differential diagnosis, because of its close correlation with infections, but it still retains some limitations and false positivity (such as in multiple trauma and burns). Soluble CD14 subtype (sCD14-ST), also known as presepsin, is a novel and promising biomarker that has been shown to increase significantly in patients with sepsis, in comparison to the healthy population. Studies pointed out the capability of this biomarker for diagnosing sepsis, assessing the severity of the disease and providing a prognostic evaluation of patient outcome. In this mini review we mainly focused on presepsin: we evaluate its diagnostic and prognostic roles in patients presenting to the ED with systemic inflammatory response syndrome (SIRS), suspected sepsis or septic shock.

scholarly journals The REDS score: a new scoring system to risk-stratify emergency department suspected sepsis: a derivation and validation study

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e030922 ◽  
Author(s):  
Narani Sivayoham ◽  
Lesley A Blake ◽  
Shafi E Tharimoopantavida ◽  
Saad Chughtai ◽  
Adil N Hussain ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Prediction Rule ◽  
Clinical Prediction Rule ◽  
Risk Category ◽  
Suspected Sepsis ◽  
Suspected Infection ◽  
Derivation Cohort ◽  
High Risk Category ◽  
Component Scores

ObjectiveTo derive and validate a new clinical prediction rule to risk-stratify emergency department (ED) patients admitted with suspected sepsis.DesignRetrospective prognostic study of prospectively collected data.SettingED.ParticipantsPatients aged ≥18 years who met two Systemic Inflammatory Response Syndrome criteria or one Red Flag sepsis criteria on arrival, received intravenous antibiotics for a suspected infection and admitted.Primary outcome measureIn-hospital all-cause mortality.MethodThe data were divided into derivation and validation cohorts. The simplified-Mortality in Severe Sepsis in the ED score and quick-SOFA scores, refractory hypotension and lactate were collectively termed ‘component scores’ and cumulatively termed the ‘Risk-stratification of ED suspected Sepsis (REDS) score’. Each patient in the derivation cohort received a score (0–3) for each component score. The REDS score ranged from 0 to 12. The component scores were subject to univariate and multivariate logistic regression analyses. The receiver operator characteristic (ROC) curves for the REDS and the components scores were constructed and their cut-off points identified. Scores above the cut-off points were deemed high-risk. The area under the ROC (AUROC) curves and sensitivity for mortality of the high-risk category of the REDS score and component scores were compared. The REDS score was internally validated.Results2115 patients of whom 282 (13.3%) died in hospital. Derivation cohort: 1078 patients with 140 deaths (13%). The AUROC curve with 95% CI, cut-off point and sensitivity for mortality (95% CI) of the high-risk category of the REDS score were: derivation: 0.78 (0.75 to 0.80); ≥3; 85.0 (78 to 90.5). Validation: 0.74 (0.71 to 0.76); ≥3; 84.5 (77.5 to 90.0). The AUROC curve and the sensitivity for mortality of the REDS score was better than that of the component scores. Specificity and mortality rates for REDS scores of ≥3, ≥5 and ≥7 were 54.8%, 88.8% and 96.9% and 21.8%, 36.0% and 49.1%, respectively.ConclusionThe REDS score is a simple and objective score to risk-stratify ED patients with suspected sepsis.

scholarly journals Treatment variables associated with outcome in emergency department patients with suspected sepsis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Narani Sivayoham ◽  
Lesley A. Blake ◽  
Shafi E. Tharimoopantavida ◽  
Saad Chughtai ◽  
Adil N. Hussain ◽  
...  
Keyword(s):  
Emergency Department ◽  
Independent Predictor ◽  
Severity Of Illness ◽  
Primary Outcome Measure ◽  
Number Needed To Treat ◽  
Suspected Sepsis ◽  
Suspected Infection ◽  
Predictors Of Mortality ◽  
Refractory Hypotension ◽  
Time To Antibiotics

Abstract Background Early treatment is advocated in the management of patients with suspected sepsis in the emergency department (ED). We sought to understand the association between the ED treatments and outcome in patients admitted with suspected sepsis. The treatments studied were: (i) the time to antibiotics, where time zero is the time the patient was booked in which is also the triage time; (ii) the volume of intravenous fluid (IVF); (iii) mean arterial pressure (MAP) after 2000 ml of IVF and (iv) the final MAP in the ED. Methods We performed a retrospective analysis of the ED database of patients aged ≥ 18 year who met two SIRS criteria or one red flag sepsis criteria on arrival, received intravenous antibiotics for a suspected infection and admitted between 8th February 2016 and 31st August 2017. The primary outcome measure was all-cause in-hospital mortality. The four treatments stated above were controlled for severity of illness and subject to multivariate logistic regression and Cox proportional-hazard regression to identify independent predictors of mortality. Results Of the 2,066 patients studied 272 (13.2%) died in hospital. The median time to antibiotics was 48 (interquartile range 30–82) minutes. The time to antibiotics was an independent predictor of mortality only in those who developed refractory hypotension (RH); antibiotics administered more than 55 mins after arrival was associated with an odds ratio (OR) for mortality of 2.75 [95% confidence interval (CI) 1.22–6.14]. The number-needed-to-treat was 4. IVF > 2000 ml (95% CI > 500– > 2100), except in RH, and a MAP ≤ 66 mmHg after 2000 ml of IVF were also independent predictors of mortality. The OR for mortality of IVF > 2,000 ml in non-RH was 1.80 (95% CI 1.15–2.82); Number-needed-to-harm was 14. The OR for morality for a MAP ≤ 66 mmHg after 2000 ml of IVF was 3.42 (95% CI 2.10–5.57). A final MAP < 75 mmHg in the ED was associated with, but not an independent predictor of mortality. An initial systolic blood pressure of < 100 mmHg has a sensitivity of 63.3% and specificity of 88.4% for the development of RH. Conclusion In this study, antibiotics were found to be time-critical in RH. Intravenous fluids > 2000 ml (except in RH) and a MAP ≤ 66 mmHg after 2000 ml of IVF were also independent predictors of mortality.

scholarly journals Correlation of Quick SOFA Score and Procalcitonin with Mortality in the Emergency Department

2020 ◽  
pp. 64-69
Author(s):  
Mandip Singh Bhatia ◽  
Ritu Attri ◽  
Kumar Rajni Kant ◽  
Saurabh C. Sharda
Keyword(s):  
Emergency Department ◽  
Early Diagnosis ◽  
Organ Dysfunction ◽  
Sofa Score ◽  
Host Response ◽  
Death Sentence ◽  
Suspected Infection ◽  
Life Threatening ◽  
Qsofa Score ◽  
Sensitive Marker

Introduction: Sepsis is defined as life-threatening organ dysfunction caused by the dysregulated host response to infection with high mortality. Early diagnosis and treatment can decrease mortality. Methods: We studied 2031 patients presenting to an emergency department with fever or suspected infection to find the correlation between q SOFA SCORE and procalcitonin levels with mortality. Results: It is seen that mortality is directly proportionate to qSofa score and we also found that the value of procalcitonin is directly proportionate to qSofa score. Conclusion: Combination of qSofa score with procalcitonin is a sensitive marker of death in sepsis. qSofa score of 2 or more is associated with increased mortality but its, not death sentence if all such patients treated aggressively & timely then the majority of them would survive.

scholarly journals Early Stratification of Sepsis Using Presepsine in Emergency Department (North-East of Romania Experience)

2017 ◽  
Vol 54 (1) ◽  
pp. 190-193
Author(s):  
Maraiana Stuparu Cretu ◽  
Ana Camelia Grigore ◽  
Adrian Maier ◽  
Tudor Ovidiu Popa ◽  
Alina Plesea Condratovici ◽  
...  
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Roc Curve ◽  
Standard Error ◽  
Health Care Systems ◽  
Intensive Therapy ◽  
Biological Marker ◽  
Suspected Sepsis ◽  
North East

Sepsiis syndrome is a common and have devastating implications on health care systems worldwide. Biomarkers may have an important role to highlight the presence, absence or severity of sepsis. Retrospective study was conducted on a group of 81 patients with suspected sepsis, presented in the Emergency Department - Emergency County Hospital St. Spiridon Iasi during 01.09.2014-30.10.2014. The obtained statistical data�s were interpreted using SPSS software and the ROC curve was calculated. The study aims was to establish the following: determining the validity of presepsin as a biological marker in sepsis diagnosis and prognosis; sepsis stratification. The mean age of patients was 64.52 years. Determination of presepsin sensitivity in sepsis early diagnosis was calculated by generating the ROC curve. Following AUC values were found: AUC = 0.709, with a standard error of 0.065 for predicting sepsis; AUC = 0.866, with a standard error of 0.080 for severe sepsis; AUC = 0.864, with a standard error of 0.053 in the presence of septic shock. The average values of presepsin, related with severity of infection, it was found to be 544.39 � 141.93 pg./mL in case of localized infection; 605.6 � 59.55 pg./ mL in patients with systemic inflammatory response syndrome; 1283.21 � 195.74 pg./ mL in patients diagnosed with sepsis; 4787.8 � 1980.43pg./mL in patients presenting severe sepsis and 3734.88 � 1732.41pg./mL in patients diagnosed with septic shock. Presepsin level, measured by using quantitative dosage methods, may be helpful in staging patients diagnosed with sepsis and may be used as an indication for initiation of intensive therapy to prevent septic shock. Presepsin level can be used as an early marker of severe prognostic in septic patients.

scholarly journals Proadrenomedullin in Sepsis and Septic Shock: A Role in the Emergency Department

Medicina ◽  
2021 ◽  
Vol 57 (9) ◽  
pp. 920
Author(s):  
Andrea Piccioni ◽  
Angela Saviano ◽  
Sara Cicchinelli ◽  
Federico Valletta ◽  
Michele Cosimo Santoro ◽  
...  
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Early Diagnosis ◽  
Literature Review ◽  
Current Knowledge ◽  
Organ Damage ◽  
Emergency Physicians ◽  
Improve Patient Survival ◽  
Sepsis And Septic Shock

Sepsis and septic shock represent a leading cause of mortality in the Emergency Department (ED) and in the Intensive Care Unit (ICU). For these life-threating conditions, different diagnostic and prognostic biomarkers have been studied. Proadrenomedullin (MR-proADM) is a biomarker that can predict organ damage and the risk of imminent death in patients with septic shock, as shown by a large amount of data in the literature. The aim of our narrative review is to evaluate the role of MR-proADM in the context of Emergency Medicine and to summarize the current knowledge of MR-proADM as a serum indicator that is useful in the Emergency Department (ED) to determine an early diagnosis and to predict the long-term mortality of patients with sepsis and septic shock. We performed an electronic literature review to investigate the role of MR-proADM in sepsis and septic shock in the context of ED. We searched papers on PubMed®, Cochrane®, UptoDate®, and Web of Science® that had been published in the last 10 years. Data extracted from this literature review are not conclusive, but they show that MR-proADM may be helpful as a prognostic biomarker to stratify the mortality risk in cases of sepsis and septic shock with different degrees of organ damage, guiding emergency physicians in the diagnosis and the succeeding therapeutic workup. Sepsis and septic shock are conditions of high complexity and have a high risk of mortality. In the ED, early diagnosis is crucial in order to provide an early treatment and to improve patient survival. Diagnosis and prognosis are often the result of a combination of several tests. In our opinion, testing for MR-proADM directly in the ED could contribute to improving the prognostic assessment of patients, facilitating the subsequent clinical management and intensive treatment by the emergency physicians, but more studies are needed to confirm these results.

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