The early identification of disease progression in patients with suspected infection presenting to the emergency department: a multi-centre derivation and validation study.
|
| Abstract | BACKGROUND: There is a lack of validated tools to assess potential disease progression and hospitalisation decisions in patients presenting to the emergency department (ED) with a suspected infection. This study aimed to identify suitable blood biomarkers (MR-proADM, PCT, lactate and CRP) or clinical scores (SIRS, SOFA, qSOFA, NEWS and CRB-65) to fulfil this unmet clinical need. METHODS: An observational derivation patient cohort validated by an independent secondary analysis across nine EDs. Logistic and Cox regression, area under the receiver operating characteristic (AUROC) and Kaplan-Meier curves were used to assess performance. Disease progression was identified using a composite endpoint of 28-day mortality, ICU admission and hospitalisation > 10 days. RESULTS: One thousand one hundred seventy-five derivation and 896 validation patients were analysed with respective 28-day mortality rates of 7.1% and 5.0%, and hospitalisation rates of 77.9% and 76.2%. MR-proADM showed greatest accuracy in predicting 28-day mortality and hospitalisation requirement across both cohorts. Patient subgroups with high MR-proADM concentrations (≥ 1.54 nmol/L) and low biomarker (PCT < 0.25 ng/mL, lactate < 2.0 mmol/L or CRP < 67 mg/L) or clinical score (SOFA < 2 points, qSOFA < 2 points, NEWS < 4 points or CRB-65 < 2 points) values were characterised by a significantly longer length of hospitalisation (p < 0.001), rate of ICU admission (p < 0.001), elevated mortality risk (e.g. SOFA, qSOFA and NEWS HR [95%CI], 45.5 [10.0-207.6], 23.4 [11.1-49.3] and 32.6 [9.4-113.6], respectively) and a greater number of disease progression events (p < 0.001), compared to similar subgroups with low MR-proADM concentrations (< 1.54 nmol/L). Increased out-patient treatment across both cohorts could be facilitated using a derivation-derived MR-proADM cut-off of < 0.87 nmol/L (15.0% and 16.6%), with decreased readmission rates and no mortalities. CONCLUSIONS: In patients presenting to the ED with a suspected infection, the blood biomarker MR-proADM could most accurately identify the likelihood of further disease progression. Incorporation into an early sepsis management protocol may therefore aid rapid decision-making in order to either initiate, escalate or intensify early treatment strategies, or identify patients suitable for safe out-patient treatment.
|
|---|---|
| Authors | Kordo Saeed, Darius Cameron Wilson, Frank Bloos, Philipp Schuetz, Yuri van der Does, Olle Melander, Pierre Hausfater, Jacopo M Legramante, Yann-Erick Claessens, Deveendra Amin, Mari Rosenqvist, Graham White, Beat Mueller, Maarten Limper, Carlota Clemente Callejo, Antonella Brandi, Marc-Alexis Macchi, Nicholas Cortes, Alexander Kutz, Peter Patka, María Cecilia Yañez, Sergio Bernardini, Nathalie Beau, Matthew Dryden, Eric C M van Gorp, Marilena Minieri, Louisa Chan, Pleunie P M Rood, Juan Gonzalez Del Castillo |
| Journal | Critical care (London, England) (Crit Care) Vol. 23 Issue 1 Pg. 40 (Feb 08 2019) ISSN: 1466-609X [Electronic] England |
| PMID | 30736862 (Publication Type: Journal Article, Multicenter Study, Observational Study) |
| Chemical References |
|
| Topics |
|
Join CureHunter, for free Research Interface BASIC access!
Realize the full power of the drug-disease research graph!