83 B-Mode Ultrasound Signs in Ovarian Torsion and Normal Doppler Blood Flow: Masses, Cysts, and Follicular Ring Sign: A Potential Diagnostic Algorithm

Abstract

Study Objective: Early identification of bacterial infection or sepsis is critical as early treatment improves outcomes. Unfortunately, there are limited diagnostic tests available that quickly and reliably identify sepsis or bacterial infection. sPLA2-IIA levels have been shown to be elevated in animal models of sepsis as well as several preliminary human studies. We sought to identify threshold values of sPLA2-IIA that predict sepsis and bacterial infection as compared to normal controls in an emergency department (ED) population.Methods: The study site is a community-based tertiary care facility. Study subjects were consenting adult patients who met 2 or more systemic inflammatory response syndrome (SIRS) criteria with clinical diagnosis of infectious source likely (septic patients). Control subjects were non-septic consenting adults undergoing blood draw for other ED indications (abdominal pain, chest pain, neurological complaints, etc). Septic patients were evaluated by hospital protocol with blood cultures, lactate, and chemistries. During the course of other laboratory evaluation both groups of patients had an extra aliquot of blood drawn, blind-coded, and sent to an outside laboratory for quantitative analysis of sPLA2-IIA levels using an enzyme linked immunoassay (EIA). The laboratory personnel did not have access to patient clinical data. sPLA2-IIA levels were reported by patient study number to the clinical investigators. Study investigators reviewed patients inpatient medical record for laboratory, imaging, and microbiology results, as well as clinical course. All data were entered into a standardized spreadsheet by a trained data abstractor. Data was non-parametric in distribution and was analyzed with descriptive statistics, Chi Square, and Mann-Whitney test. The study was IRB approved.Results: Compared to the controls, sepsis/severe sepsis patients were significantly older (64.1 versus 48.4, p¼0.003). We have enrolled 10 patients with severe sepsis, 15 with sepsis, and 18 controls. Patients with sepsis/severe sepsis had a median sPLA2-IIA level of 115 ng/ml (IQR 61.9-261) as compared to controls (median 16ng/ml, IQR 9-23.8, p <0.0001). sPLA2-IIA levels were not helpful in distinguishing sepsis from severe sepsis (p¼0.60). Using a cut-off value of 50ng/ml as a threshold value for sepsis/ severe sepsis, sPLA2-IIA EIA had a sensitivity of 0.76 ) and a specificity of 94.4 (CI 70.6-99.7). sPLA2-IIA displayed a weak correlation with lactate, with an r of 0.22.Conclusions: sPLA2-IIA measurement shows potential as a specific marker for sepsis/severe sepsis and may be clinically useful to identify a high-risk subset of patients with infectious processes. Further study is warranted to identify predictive value of trends in sPLA2-IIA during disease course in septic patients and to clarify the impact of age on sPLA2-IIA, if any.