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

Autor: Gornet M; Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100 Reims, France., Leroux P; Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100 Reims, France., Ramont L; Biochemistry Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100 Reims, France; Université de Reims Champagne-Ardenne, SFR CAP-Santé (FED 4231), Laboratoire de Biochimie Médicale et Biologie Moléculaire, 51 rue Cognacq-Jay, 51100 Reims, France; CNRS UMR 7369, Matrice Extracellulaire et Dynamique Cellulaire-MEDyC, 51 rue Cognacq-Jay, 51100 Reims, France. Electronic address: lramont@chu-reims.fr., De Ruffi S; Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100 Reims, France., Giordano Orsini G; Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100 Reims, France; Université de Reims Champagne-Ardenne, UFR Médecine, 51 rue Cognacq-Jay, 51100 Reims, France. Electronic address: ggiordano-orsini@chu-reims.fr., Losset X; Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100 Reims, France. Electronic address: xlosset@chu-reims.fr., Kanagaratnam L; Université de Reims Champagne-Ardenne, UFR Médecine, 51 rue Cognacq-Jay, 51100 Reims, France; Clinical Research Unit, Reims University Hospital, 45 rue Cognacq-Jay, 51100 Reims, France. Electronic address: lkanagaratnam@chu-reims.fr., Gennai S; Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100 Reims, France; Université de Reims Champagne-Ardenne, UFR Médecine, 51 rue Cognacq-Jay, 51100 Reims, France. Electronic address: sgennai@chu-reims.fr.
Jazyk: angličtina
Zdroj: The American journal of emergency medicine [Am J Emerg Med] 2021 Sep; Vol. 47, pp. 109-114. Date of Electronic Publication: 2021 Mar 26.
DOI: 10.1016/j.ajem.2021.03.050
Abstrakt: Introduction: Initial procalcitonin (PCT) levels may fail in mortality and septic shock prediction and raise cost-effectiveness issues. Since measurement of lactate, C-reactive protein (CRP), white blood cells and neutrophils is common in the emergency department (ED), we compared prediction abilities of these biomarkers to PCT.
Methods: From January 1st to December 31st, 2018, an observational, single center, retrospective study was conducted in the adult ED of the Reims University Hospital (France). Endpoints were bacteremia, septic shock, and in-hospital mortality, related to the same ED visit.
Results: Over one year, 459 patients suspected with infection were included, of mean age 60.4 years (SD: 22.0), with 50.8% male, and 364 (79.3%) were hospitalized following ED visit. Overall, 45 (9.8%) patients had a bacteremia, 39 (8.5%) a septic shock and 54 (11.8%) died during their hospitalization. PCT and CRP showed the best discrimination for bacteremia, with an area under curve (AUC) of 0.68 for PCT and 0.65 for CRP. PCT and lactate showed similar good discriminative power for septic shock, with an AUC of 0.78 for both, and poor discrimination for in-hospital mortality, with an AUC of 0.62 for PCT and 0.69 for lactate. Systolic blood pressure and pulse oximetry showed similar discrimination for septic shock as PCT or lactate, while they showed higher discrimination for in-hospital mortality than PCT.
Conclusion: Usual admission biomarkers lack clinical utility in predicting septic shock or in-hospital mortality. CRP and PCT are poorly efficient in predicting bacteremia.
Competing Interests: Declaration of Competing Interest None.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: