Can We Improve Mortality Prediction in Patients with Sepsis in the Emergency Department?
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Population Inclusion Criteria
2.3. Data Collection
2.4. Sample Collection and Biomarker Assays
2.5. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
APACHE II | Acute Physiology and Chronic Health Evaluation II |
AUC | Area Under the Curve |
AZU1 | Azurocidin 1 |
CCI | Charlson Comorbidity Index |
CI | Confidence Interval |
ED | Emergency Department |
GCS | Glasgow Coma Scale |
hsCRP | High-sensitivity C-reactive protein |
ICU | Intensive Care Unit |
IL-6 | Interleukin-6 |
IQR | Inter-quartile range |
MEDS | Mortality in Emergency Department Sepsis |
NEWS | National Early Warning Score |
PCT | Procalcitonin |
qSOFA | Quick Sequential Organ Failure Assessment |
SAPS II and III | Simplified Acute Physiology Score II and III |
Se | Sensitivity |
SIRS | Systemic Inflammatory Response Syndrome |
SOFA | Sequential Organ Failure Assessment |
Sp | Specificity |
sTREM-1 | Soluble Triggering Receptor Expressed on Myeloid Cells-1 |
suPAR | Soluble urokinase plasminogen activator |
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Characteristics [Median (IQR)] | Survivors (Group = 34) | Non-Survivors (Group = 33) | p | |
---|---|---|---|---|
Gender, n (%) | ||||
Male | 16 (47.1) | 12 (36.4) | 0.52 * | |
Female | 18 (52.9) | 21 (63.6) | ||
Age, years | 72 (63.75–81.25) | 78 (65.5–85) | 0.11 ** | |
Recent hospitalization, n (%) | 6 (17.6) | 7 (21.2) | 0.95 * | |
ICU stay (days) | 2 (1–11.75) | 5 (2–9) | 0.48 ** | |
Oxygen mask, n (%) | 18 (52.9) | 17 (51.5) | 1.00 * | |
Mechanical ventilation, n (%) | 3 (8.8) | 17 (51.5) | <0.001 * | |
Non-invasive ventilation, n (%) | 0 (0) | 2 (6.1) | 0.23 * | |
Vasoactive, n (%) | 7 (20.6) | 12 (36.4) | 0.24 * | |
Antibiotics administered, (n%) | 1 | 22 (75.9) | 24 (85.7) | 0.54 * |
2 | 7 (24.1) | 4 (14.3) | ||
Parameters | ||||
Heart rate | 110 (93.5–115.25) | 115.25 (100.5–124.5) | 0.14 ** | |
Mean arterial pressure (mmHg) | 63 (56.75–72.25) | 60 (53–65.5) | 0.14 ** | |
Temperature (˚C) | 38 (36–39) | 37 (36–38) | 0.01 ** | |
Oxygen Saturation (%) | 94.5 (88.75–97) | 94 (86–97) | 0.50 ** | |
Lactate (mmol/L) | 2 (1–3) | 4 (2–7.5) | <0.001 ** | |
Comorbidities, n (%) | ||||
Cardiovascular disease | 27 (79.4) | 29 (87.9) | 0.54 * | |
Diabetes | 19 (55.9) | 17 (51.5) | 0.91 * | |
Chronic kidney disease | 9 (26.5) | 7 (21.2) | 0.82 * | |
Chronic lung disease | 9 (26.5) | 5 (15.2) | 0.40 * | |
Obesity | 15 (44.1) | 11 (33.3) | 0.51 * | |
Neuropsychiatry | 14 (41.2) | 21 (63.6) | 0.11 * | |
Site of sepsis, n (%) | ||||
Neurologic | 0 (0) | 1 (3) | 0.49 * | |
Respiratory | 15 (44.1) | 21 (63.6) | 0.17 * | |
Cardiac | 0 (0) | 1 (3) | 0.49 * | |
Digestive | 8 (23.5) | 4 (12.1) | 0.36 * | |
Skin and soft tissue | 13 (38.2) | 13 (39.4) | 1.00 * | |
Urinary | 24 (70.6) | 20 (60.6) | 0.54 * |
Parameters † | Survival Group | Non-Survival Group | p | |
---|---|---|---|---|
Biomarkers | ||||
sTREM-1 (pg/mL) | 185.3 (80.70–722.90) | 274.5 (94.55–967.95) | 0.59 ** | |
hsCRP (pg/mL) | 26.05 (16–29.95) | 18.4 (15.75–24.30) | 0.10 ** | |
PCT (pg/mL) | 9.4 (2.70–20.67) | 15.2 (4.70–56.10) | 0.09 ** | |
AZU1 (ng/mL) | 8.3 (7.47–9.12) | 7.6 (6.90–8.55) | 0.05 ** | |
suPAR (ng/mL) | 7421 (6060.75–8900.25) | 8256 (6995–9601) | 0.05 ** | |
IL-6 (pg/mL) | 290.4 (76.30–529.22) | 694 (346.50–858.30) | <0.001 ** | |
Scores, n (%) | ||||
SIRS | 2 | 7 (20.60) | 6 (18.20) | 0.52 * |
3 | 14 (41.20) | 18 (54.50) | ||
4 | 13 (38.20) | 9 (27.20) | ||
qSOFA | 1 | 8 (23.50) | 2(6.10) | 0.001 * |
2 | 18 (52.90) | 8 (24.20) | ||
3 | 8 (23.50) | 23 (69.70) | ||
GCS | 15 (12.75–15) | 11 (6.50–14.50) | <0.001 ** | |
CCI | CCI Score | 6.5 (4–9) | 7 (6–9) | 0.34 ** |
CCI % | 1 (0–53) | 0 (0–2) | 0.14 ** | |
NEWS | 10 (7–12) | 13 (10.5–15) | 0.003 ** | |
MEDS score | 12.5 (11–16) | 16 (11–17) | 0.14 ** | |
SOFA | 5 (3–9.25) | 10 (7–13) | 0.001 ** | |
APACHE II | APACHEII score | 21 (14.75–24.25) | 26 (21.50–33) | <0.001 ** |
APACHE II % | 40 (22.50–46.75) | 55 (40–73) | <0.001 ** | |
SAPS II | SAPS II score | 46.5 (39.75–56.75) | 66 (56–85) | <0.001 ** |
SAPS II % | 38.1 (27.12–61.37) | 78.5 (59.8–95) | <0.001 ** | |
SAPS III | SAPS III score | 64.5 (59–71.25) | 81 (69.50–95) | <0.001 ** |
SAPS III % | 45 (33.87–58.97) | 75 (56–88.55) | <0.001 ** |
AUC (95% CI) | Cutoff | Se (95% CI) | Sp (95% CI) | p | |
---|---|---|---|---|---|
Biomarkers | |||||
IL-6 (pg/mL) | 0.73 (0.61–0.83) | >538 | 63.64 (45.1–79.6) | 79.41 (62.1–91.3) | <0.001 |
suPAR (ng/mL) | 0.63 (0.51–0.75) | >7447 | 69.70 (51.3–84.4) | 58.82 (40.7–75.4) | 0.04 |
PCT (pg/mL) | 0.62 (0.49–0.73) | >19.8 | 48.48 (30.8–66.5) | 76.47 (58.8–89.3) | 0.08 |
hsCRP (pg/mL) | 0.61 (0.48–0.73) | ≤24.9 | 81.82 (64.5–93.0) | 52.94 (35.1–70.2) | 0.10 |
sTREM-1 (pg/mL) | 0.53 (0.41–0.66) | >189 | 63.64 (45.1–79.6) | 52.94 (35.1–70.2) | 0.59 |
AZU1 (ng/mL) | 0.63 (0.5–0.7) | ≤7.7 | 63.64 (45.1–79.6) | 67.65 (49.5–82.6) | 0.05 |
Scores | |||||
GCS | 0.75 (0.63–0.85) | ≤12 | 66.67 (48.2–82.0) | 76.47 (58.8–89.3) | <0.001 |
NEWS | 0.71 (0.58–0.81) | >11 | 69.7 (51.3–84.4) | 73.53 (55.6–87.1) | 0.001 |
SOFA | 0.74 (0.62–0.84) | >6 | 81.82 (64.5–93) | 58.82 (40.7–75.4) | <0.001 |
APACHE II | 0.77 (0.66–0.87) | >23 | 69.7 (51.3–84.4) | 73.53 (55.6–87.1) | <0.001 |
SAPS II | 0.82 (0.70–0.90) | >43.8 | 93.94 (79.8–99.3) | 61.76 (43.6–77.8) | <0.001 |
SAPS III | 0.82 (0.71–0.90) | >67 | 90.91 (75.7–98.1) | 67.65 (49.5–82.6) | <0.001 |
Combinations | |||||
IL-6 + suPAR | 0.74 (0.62–0.84) | >0.54 | 66.67 (48.2–82) | 76.47 (58.8–89.3) | <0.001 |
IL-6 + AZU | 0.78 (0.66–0.87) | >0.34 | 90.91 (75.7–98.1) | 52.94 (35.1–70.2) | <0.001 |
IL-6 + SOFA + SAPSII + APACHE II | 0.85 (0.75–0.93) | >0.61 | 63.64 (45.1–79.6) | 94.12 (80.3–99.3) | <0.001 |
IL-6 + AZU + SOFA + SAPSII + APACHE II | 0.82 (0.76–0.94) | >0.53 | 75.76 (57.7–88.9) | 82.35 (65.5–93.2) | <0.001 |
IL-6 + suPAR + AZU + SOFA + SAPSII+ APACHE II | 0.86 (0.76–0.93) | >0.53 | 75.76 (57.7–88.9) | 82.35 (65.5–93.2) | <0.001 |
SOFA + SAPSII + APACHEII | 0.83 (0.72–0.91) | >0.4 | 81.82 (54.5–93) | 70.59 (52.5–84.9) | <0.001 |
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Luka, S.; Golea, A.; Vesa, Ș.C.; Leahu, C.-E.; Zăgănescu, R.; Ionescu, D. Can We Improve Mortality Prediction in Patients with Sepsis in the Emergency Department? Medicina 2024, 60, 1333. https://doi.org/10.3390/medicina60081333
Luka S, Golea A, Vesa ȘC, Leahu C-E, Zăgănescu R, Ionescu D. Can We Improve Mortality Prediction in Patients with Sepsis in the Emergency Department? Medicina. 2024; 60(8):1333. https://doi.org/10.3390/medicina60081333
Chicago/Turabian StyleLuka, Sonia, Adela Golea, Ștefan Cristian Vesa, Crina-Elena Leahu, Raluca Zăgănescu, and Daniela Ionescu. 2024. "Can We Improve Mortality Prediction in Patients with Sepsis in the Emergency Department?" Medicina 60, no. 8: 1333. https://doi.org/10.3390/medicina60081333
APA StyleLuka, S., Golea, A., Vesa, Ș. C., Leahu, C. -E., Zăgănescu, R., & Ionescu, D. (2024). Can We Improve Mortality Prediction in Patients with Sepsis in the Emergency Department? Medicina, 60(8), 1333. https://doi.org/10.3390/medicina60081333