Biomarkers and clinical scores to aid the identification of disease severity and intensive care requirement following activation of an in-hospital sepsis code

Abstract

Background: Few validated biomarker or clinical score combinations exist which can discriminate between cases of infection and other non-infectious conditions following activation of an in-hospital sepsis code, as well as provide an accurate severity assessment of the corresponding host response. This study aimed to identify suitable blood biomarker (MR-proADM, PCT, CRP and lactate) or clinical score (SOFA and APACHE II) combinations to address this unmet clinical need. Methods: A prospective, observational study of patients activating the Vall d'Hebron University Hospital sepsis code (ISC) within the emergency department (ED), hospital wards and intensive care unit (ICU). Area under the receiver operating characteristic (AUROC) curves, logistic and Cox regression analysis were used to assess performance. Results: 148 patients fulfilled the Vall d'Hebron ISC criteria, of which 130 (87.8%) were retrospectively found to have a confirmed diagnosis of infection. Both PCT and MR-proADM had a moderate-to-high performance in discriminating between infected and non-infected patients following ISC activation, although the optimal PCT cutoff varied significantly across departments. Similarly, MR-proADM and SOFA performed well in predicting 28-and 90-day mortality within the total infected patient population, as well as within patients presenting with a community-acquired infection or following a medical emergency or prior surgical procedure. Importantly, MR-proADM also showed a high association with the requirement for ICU admission after ED presentation [OR (95% CI) 8.18 (1.75-28.33)] or during treatment on the ward [OR (95% CI) 3.64 (1.43-9.29)], although the predictive performance of all biomarkers and clinical scores diminished between both settings. Conclusions: Results suggest that the individual use of PCT and MR-proADM might help to accurately identify patients with infection and assess the overall severity of the host response, respectively. In addition, the use of MR-proADM could accurately identify patients requiring admission onto the ICU, irrespective of whether patients

MR‐proADM as marker of endotheliitis predicts COVID‐19 severity

“…In the setting of infectious disease, MR-proADM has been reported as a useful marker for differentiating between infection and sepsis 22,37 and for an early stratification of severity in patients with sepsis. 15,38,39 Few studies have evaluated the potential role of MR-ProADM in viral infections and most of them have been limited to 18 in a small cohort of patients with influenza A virus pneumonia, obtained a ROC AUC of 0.871 to predict mortality, with an optimal cut-off of 1.12 nmol/L.…”

Clinical decision support tool and rapid point-of-care platform for determining disease severity in patients with COVID-19

“…S1 †) and AUC values (Table S1 †). The median (IQR) COVID-19 Severity Scores were significantly higher for those that died vs. those that were discharged (59 [40-83] vs. 9 [6][7][8][9][10][11][12][13][14][15][16][17], respectively). Patients who underwent any invasive or noninvasive ventilation were at an intermediate risk of death with median (IQR) scores of 17 (10-39) (Fig.…”

“…Likewise, ruling out and/or reducing the admission of patients with very low risk of complications who can be safely managed through self-quarantine would conserve precious medical resources during a surge of new cases in an outbreak. While clinical decision support tools have been developed for sepsis disease severity 15 and are in development for COVID-19 disease severity, 16 to our knowledge there are no scoring systems for COVID-19 disease severity that are intricately linked to the biomarker tests at the point of care or based on lab-on-a-chip platforms. Access to an integrated test and scoring system for use at the point of care and in low-and middle-income countries would help to manage this disease on a global basis.…”

The Surviving Sepsis Campaign: research priorities for the administration, epidemiology, scoring and identification of sepsis

“…Relatively little is known about pre-hospital emergency care [46]. There is ongoing need for better indicators for triage of critical care resources [47]. Nunnally…”