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The early identific...
The early identification of disease progression in patients with suspected infection presenting to the emergency department : A multi-centre derivation and validation study
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- Saeed, Kordo (author)
- University of Southampton,North Hampshire Hospital
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- Wilson, Darius Cameron (author)
- Brahms GmbH
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- Bloos, Frank (author)
- Universitätsklinikum Jena
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- Schuetz, Philipp (author)
- University of Basel,Cantonal Hospital Aarau
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- Van Der Does, Yuri (author)
- Erasmus University Medical Center
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- Melander, Olle (author)
- Lund University,Lunds universitet,Kardiovaskulär forskning - hypertoni,Forskargrupper vid Lunds universitet,Cardiovascular Research - Hypertension,Lund University Research Groups,Skåne University Hospital
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- Hausfater, Pierre (author)
- Pitié-Salpêtrière University Hospital
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- Legramante, Jacopo M. (author)
- University of Rome Tor Vergata,Tor Vergata University Hospital
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- Claessens, Yann Erick (author)
- Monaco Princess Grace Hospital
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- Amin, Deveendra (author)
- Morton Plant Hospital
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- Rosenqvist, Mari (author)
- Lund University,Lunds universitet,Kardiovaskulär forskning - hypertoni,Forskargrupper vid Lunds universitet,Cardiovascular Research - Hypertension,Lund University Research Groups,Skåne University Hospital
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- White, Graham (author)
- North Hampshire Hospital
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- Mueller, Beat (author)
- University of Basel,Cantonal Hospital Aarau
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- Limper, Maarten (author)
- University Medical Center Utrecht,Utrecht University
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- Callejo, Carlota Clemente (author)
- Hospital Clinico San Carlos de Madrid
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- Brandi, Antonella (author)
- Tor Vergata University Hospital
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- MacChi, Marc Alexis (author)
- Monaco Princess Grace Hospital
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- Cortes, Nicholas (author)
- University of Southampton,St Bernard's Hospital,North Hampshire Hospital
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- Kutz, Alexander (author)
- Cantonal Hospital Aarau
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- Patka, Peter (author)
- Erasmus University Medical Center
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- Yañez, María Cecilia (author)
- Hospital Clinico San Carlos de Madrid
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- Bernardini, Sergio (author)
- Tor Vergata University Hospital,University of Rome Tor Vergata
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- Beau, Nathalie (author)
- Monaco Princess Grace Hospital
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- Dryden, Matthew (author)
- Rare and imported pathogens laboratory (RIPL),North Hampshire Hospital,University of Southampton
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- Van Gorp, Eric C.M. (author)
- Erasmus University Medical Center
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- Minieri, Marilena (author)
- Tor Vergata University Hospital,University of Rome Tor Vergata
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- Chan, Louisa (author)
- North Hampshire Hospital
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- Rood, Pleunie P.M. (author)
- Erasmus University Medical Center
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- Del Castillo, Juan Gonzalez (author)
- Hospital Clinico San Carlos de Madrid
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(creator_code:org_t)
- 2019-02-08
- 2019
- English.
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In: Critical Care. - : Springer Science and Business Media LLC. - 1364-8535. ; 23:1
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Abstract
Subject headings
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- 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
Keyword
- Disease progression
- Emergency department
- MR-proADM
- qSOFA
- Sepsis
- SOFA
Publication and Content Type
- art (subject category)
- ref (subject category)
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- By the author/editor
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Saeed, Kordo
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Wilson, Darius C ...
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Bloos, Frank
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Schuetz, Philipp
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Van Der Does, Yu ...
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Melander, Olle
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Hausfater, Pierr ...
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Legramante, Jaco ...
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Claessens, Yann ...
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Amin, Deveendra
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Rosenqvist, Mari
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White, Graham
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Mueller, Beat
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Limper, Maarten
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Callejo, Carlota ...
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Brandi, Antonell ...
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MacChi, Marc Ale ...
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Cortes, Nicholas
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Kutz, Alexander
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Patka, Peter
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Yañez, María Cec ...
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Bernardini, Serg ...
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Beau, Nathalie
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Dryden, Matthew
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Van Gorp, Eric C ...
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Minieri, Marilen ...
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Chan, Louisa
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Rood, Pleunie P. ...
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Del Castillo, Ju ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Anesthesiology a ...
- Articles in the publication
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Critical Care
- By the university
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Lund University