Lack of admission biomarkers' clinical utility in outcomes prediction in patients suspected with infection in the emergency department

Gornet, Marion; Leroux, Pierre; Ramont, Laurent; Ruffi, Sébastien De; Orsini, Guillaume Giordano; Losset, Xavier; Kanagaratnam, Lukshe; Gennai, Stéphane

doi:10.1016/j.ajem.2021.03.050

Cited by 7 publications

(16 citation statements)

References 16 publications

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“…We also showed no discriminative power of PCT in ICU admission prediction in patients rated FRENCH 1 or 2 at ED nurse triage or with an SBP <100 mmHg or a GCS <15. This finding reflects the superiority of the semiology over PCT in predicting ICU admission, reducing the interest of its prescription for this purpose, in accordance with previous work [ 28 ].…”

Section: Discussionsupporting

confidence: 91%

Clinical Outcome Predictive Value of Procalcitonin in Patients Suspected with Infection in the Emergency Department

Leroux

Ruffi

Ramont

et al. 2021

Emergency Medicine International

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Procalcitonin (PCT) may be useful for early risk stratification in the emergency department (ED), but the transposition of published data to routine emergency practice is sometimes limited. An observational retrospective study was conducted in the adult ED of the Reims University Hospital (France). Over one year, 852 patients suspected of infection were included, of mean age 61.7 years (SD: 22.6), and 624 (73.2%) were hospitalized following ED visit. Overall, 82 (9.6%) patients died during their hospitalization with an odds ratio (OR) of 5.10 (95% CI: 2.19–11.87) for PCT ≥ 0.5, in multivariate logistic regression analyses. Moreover, 78 (9.2%) patients were admitted to an ICU, 74 (8.7%) had attributable bacteremia, and 56 (6.6%) evolved toward septic shock with an OR of 4.37 (2.08–9.16), 6.38 (2.67–15.24), and 6.38 (2.41–16.86), respectively, for PCT ≥ 0.5. The highest discriminatory values were found for patients with age <65 years, but PCT lost its discrimination power for in-hospital mortality in patients with a bronchopulmonary infection site or a temperature ≥37.8°C and for ICU admission in patients with severe clinical presentations. PCT could be helpful in risk stratification, but several limitations must be considered, including being sometimes outperformed by a simple clinical examination.

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Section: Discussionsupporting

confidence: 91%

Clinical Outcome Predictive Value of Procalcitonin in Patients Suspected with Infection in the Emergency Department

Leroux

Ruffi

Ramont

et al. 2021

Emergency Medicine International

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“…Nueve se desarrollaron en España [ 37 , 39 , 40 , 43 , 44 , 46 , 48 , 49 , 53 ], siete en otros países europeos [ 36 , 41 , 45 , 50 , 51 , 52 , 54 ] y tres en Asia [ 38 , 42 , 47 ]. En total se han incluido 18.120 pacientes con 2.877 bacteriemias verdaderas (15,88 %).…”

Section: Resultsunclassified

“…En la tabla 2 se muestra la evaluación de la calidad de los estudios de cohortes incluidos y de sus riesgos de sesgos según la escala NOS [ 34 ]: 9 de ellos fueron calificados de calidad alta (bajo riesgo de sesgos) [ 26 , 36 , 37 , 39 , 40 , 41 , 43 , 49 , 50 ], 9 moderada [ 38 , 42 , 44 , 45 , 46 , 47 , 48 , 52 , 53 ] y 1 baja (alto riesgo de sesgos) [ 51 ]. Para los estudios incluidos y agrupados de la revisión sistemática [ 24 ] se asumió el análisis publicado en la misma que utilizó para la evaluación de la calidad la herramienta Quality Assessment of Diagnostic Accuracy Studies (QUADAS) [ 71 ], cuyas puntuaciones oscilan entre 0 y 14, para evaluar la calidad metodológica de los estudios incluidos.…”

Section: Resultsunclassified

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Diagnostic accuracy of procalcitonin for bacteremia in the emergency department: a systematic review

Julián-Jiménez,

Eduardo García,

Merinos-Sánchez

et al. 2023

Rev Esp Quimioter

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Introduction. Obtaining blood cultures (HC) is performed in 15% of the patients treated with suspicion of infection in the Hospital Emergency Services (ED) with a variable diagnostic yield (2-20%). The 30-day mortality of patients with bacteremia is two or three times higher than the rest with the same process. Procalcitonin (PCT) is a biomarker that has been used as a tool to help predict bacteremia in HEDs. The main objective of this systematic review is to investigate the diagnostic accuracy of PCT in predicting true bacteraemia in adult patients treated with clinical suspicion of infection in the ED, as well as to identify a specific PCT value as the most relevant from the clinical decision diagnostic point of view that can be recommended for decision making Method. A systematic review was performed following the PRISMA guidelines in the PubMed, Web of Science, EMBASE, Lilacs, Cochrane, Epistemonikos, Tripdatabase and ClinicalTrials.gov databases from January 2010 to May 31, 2023 without language restrictions and using a combination of MESH terms: “Bacteremia/ Bacteraemia/ Blood Stream Infection”, “Procalcitonin”, “Emergencies/ Emergency/ Emergency Department” and “Adults”. Observational cohort studies and partially an systematic review were included. No meta-analysis techniques were performed, but the results were compared narratively. Results. A total of 1,372 articles were identified, of which 20 that met the inclusion criteria were finally analyzed. The included studies represent a total of 18,120 processed HC with 2,877 bacteraemias (15.88%). Ten studies were rated as high, 9 moderate and 1 low quality. The AUC-COR of all the studies ranges from 0.68 (95% CI: 0.59-0.77) to 0.98 (95% CI: 0.97-0.99). The PCT value >0.5 ng/ml is the most widely used and proposed in up to ten of the works included in this systematic review, whose estimated mean yield is an AUC-COR of 0.833. If only the results of the 6 high-quality studies using a cut-off point (PC) >0.5 ng/mL PCT are taken into account, the estimated mean AUC-COR result is 0.89 with Se of 77.6% and It is 78%. Conclusions. PCT has a considerable diagnostic accuracy of bacteraemia in patients treated in EDs for different infectious processes. The CP>0.5 ng/ml has been positioned as the most suitable for predicting the existence of bacteraemia and can be used to reasonably rule it out.

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“…For instance, C-reactive protein and procalcitonin were found to have moderate discrimination for bacteremia in 459 patients with suspected infection (AUC 0.68 and 0.65), whereas the predictive value for 28-day all-cause mortality was even inferior to systolic blood pressure and pulse oximetry. 29 A recently published hypothesis-generating meta-analysis suggested that N-terminal pro-B-type natriuretic peptide (NT-proBNP) may be associated with prognosis in sepsis or septic shock (AUC = 0.787). However, patients’ characteristics significantly differed among the 35 included studies.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic and Prognostic Significance of the Prothrombin Time/International Normalized Ratio in Sepsis and Septic Shock

Schupp

Weidner

Rusnak

et al. 2022

Clin Appl Thromb Hemost

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Objective The study investigates the diagnostic and prognostic significance of the prothrombin time/international normalized ratio (PT/INR) in patients with sepsis and septic shock. Background Sepsis may be complicated by disseminated intravascular coagulation (DIC). While the status of coagulopathy of septic patients is represented within the sepsis-3 definition by assessing the platelet count, less data regarding the prognostic impact of the PT/INR in patients admitted with sepsis and septic shock is available. Methods Consecutive patients with sepsis and septic shock from 2019 to 2021 were included. Blood samples were retrieved from day of disease onset (ie, day 0), as well as on day 1, 2, 4, 6 and 9 thereafter. Firstly, the diagnostic value of the PT/INR in comparison to the activated partial thromboplastin time (aPTT) was tested for septic shock compared to sepsis without shock. Secondly, the prognostic value of the PT/INR for 30-day all-cause mortality was tested. Statistical analyses included univariable t-tests, Spearman's correlations, C-statistics, Kaplan-Meier analyses and Cox proportional regression analyses. Results 338 patients were included (56% sepsis without shock, 44% septic shock). The overall rate of all-cause mortality at 30 days was 52%. With an area under the curve (AUC) of 0.682 ( p= .001) on day 0, the PT/INR revealed moderate discrimination of septic shock and sepsis without shock. Furthermore, PT/ INR was able to discriminate non-survivors and survivors at 30 days (AUC = 0.612; p = .001). Patients with a PT/INR >1.5 had higher rates of 30-day all-cause mortality than patients with lower values (mortality rate 73% vs 48%; log rank p = .001; HR = 2.129; 95% CI 1.494-3.033; p = .001), even after multivariable adjustment (HR = 1.793; 95% CI 1.343-2.392; p = .001). Increased risk of 30-day all-cause mortality was observed irrespective of concomitant thrombocytopenia. Conclusion The PT/INR revealed moderate diagnostic accuracy for septic shock but was associated with reliable prognostic accuracy with regard to 30-day all-cause mortality in patients admitted with sepsis and septic shock.

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Lack of admission biomarkers' clinical utility in outcomes prediction in patients suspected with infection in the emergency department

Cited by 7 publications

References 16 publications

Clinical Outcome Predictive Value of Procalcitonin in Patients Suspected with Infection in the Emergency Department

Clinical Outcome Predictive Value of Procalcitonin in Patients Suspected with Infection in the Emergency Department

Diagnostic accuracy of procalcitonin for bacteremia in the emergency department: a systematic review

Diagnostic and Prognostic Significance of the Prothrombin Time/International Normalized Ratio in Sepsis and Septic Shock

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