Predicting mortality in adult patients with sepsis in the emergency department by using combinations of biomarkers and clinical scoring systems: a systematic review

Abstract

Background Sepsis can be detected in an early stage in the emergency department (ED) by biomarkers and clinical scoring systems. A combination of multiple biomarkers or biomarker with clinical scoring system might result in a higher predictive value on mortality. The goal of this systematic review is to evaluate the available literature on combinations of biomarkers and clinical scoring systems on 1-month mortality in patients with sepsis in the ED. Methods We performed a systematic search using MEDLINE, EMBASE and Google Scholar. Articles were included if they evaluated at least one biomarker combined with another biomarker or clinical scoring system and reported the prognostic accuracy on 28 or 30 day mortality by area under the curve (AUC) in patients with sepsis. We did not define biomarker cut-off values in advance. Results We included 18 articles in which a total of 35 combinations of biomarkers and clinical scoring systems were studied, of which 33 unique combinations. In total, seven different clinical scoring systems and 21 different biomarkers were investigated. The combination of procalcitonin (PCT), lactate, interleukin-6 (IL-6) and Simplified Acute Physiology Score-2 (SAPS-2) resulted in the highest AUC on 1-month mortality. Conclusion The studies we found in this systematic review were too heterogeneous to conclude that a certain combination it should be used in the ED to predict 1-month mortality in patients with sepsis. Future studies should focus on clinical scoring systems which require a limited amount of clinical parameters, such as the qSOFA score in combination with a biomarker that is already routinely available in the ED.

Emerging roles of fibroblast growth factor 21 in critical disease

“…One of which is the lack of biomarkers with sufficient sensitivity and specificity for critical illnesses, although some progress has been made in the recent two decades (3,4). The new molecules and serologic markers that have been 10.3389/fcvm.2022.1053997 discovered for the clinical management of critical illnesses are restricted by many factors (5)(6)(7). The foremost problem is the challenge of applying biomarkers with speed and accuracy during routine clinical care.…”

Rapid identification of sepsis in the emergency department

“…One of the few currently commercially available tests in the broad category of host response assays from which experience can be drawn is procalcitonin, for which widespread adoption in EDs has not been achieved. 28 Further, recent systematic reviews point to shortfalls and lack of consensus on use of biomarkers for sepsis in the ED, 29 particularly because many are directed toward identifying bacterial etiologies only. 30 Lessons for achieving clinical integration of new and evolving tests into patient care in the ED might be learned from experience with previous assay development related to other acute clinical syndromes, where successive refinements have resulted in achieving a critical level of diagnostic accuracy.…”

“…One of the few currently commercially available tests in the broad category of host response assays from which experience can be drawn is procalcitonin, for which widespread adoption in EDs has not been achieved. 28 Further, recent systematic reviews point to shortfalls and lack of consensus on use of biomarkers for sepsis in the ED, 29 particularly because many are directed toward identifying bacterial etiologies only. 30 …”

Scoring Systems to Evaluate the Mortality Risk of Patients with Emphysematous Cystitis: A Retrospective Observational Study

“…It is also widely used to predict the mortality risk for patients with community-acquired bacteremia in Taiwan. In a recent study, the REMS score was applied to patients with COVID-19 and influenced its risk stratification [ 34 , 35 , 36 , 37 , 38 ]. Olsson et al created the REMS score in 2004 and the parameters were listed in Table 7 .…”