Best diagnostic accuracy of sepsis combining SIRS criteria or qSOFA score with Procalcitonin and Mid-Regional pro-Adrenomedullin outside ICU

Silvia Spoto,Marta Fogolari,Lucia De Florio,Sebastiano Costantino,Edoardo Nobile,Silvia Angeletti,Damiano Caputo,Massimo Ciccozzi,Emanuele Valeriani,Domenico Benvenuto,Emanuele Paolo Rafano Carnà

doi:10.1038/s41598-020-73676-y

Abstract

Early diagnosis and treatment significantly reduce sepsis mortality. Currently, no gold standard has been yet established to diagnose sepsis outside the ICU. The aim of the study was to evaluate the diagnostic accuracy of sepsis defined by SIRS Criteria of 1991,Second Consensus Conference Criteria of 2001, modified Second Consensus Conference Criteria of 2001 (obtaining SIRS Criteria and SOFA score), Third Consensus Conference of 2016, in addition to the dosage of Procalcitonin (PCT) and MR-pro-Adrenomedullin (MR-proADM). In this prospective study, 209 consecutive patients with clinical diagnosis of sepsis were enrolled (May 2014–June 2018) outside intensive care unit (ICU) setting. A diagnostic protocol could include SIRS criteria or qSOFA score evaluation, rapid testing of PCT and MR-proADM, and SOFA score calculation for organ failure definition. Using this approach outside the ICU, a rapid diagnostic and prognostic evaluation could be achieved, also in the case of negative SIRS, qSOFA or SOFA scores with high post-test probability to reduce mortality and improve outcomes.

Highlights

Abbreviations APACHE Acute Physiology and Chronic Health areas under the curves (AUCs) Areas under the curve complete blood counts (CBC) Complete blood counts CRP C-reactive protein intensive care unit (ICU) Intensive care unit IL-6 Interleukin 6 MR-proADM Mid-Regional pro-Adrenomedullin PCR Polymerase chain reaction PCT Procalcitonin positive predictive value (PPV) Positive predictive value quick SOFA (qSOFA) Quick ROC Receiver operating characteristic systemic inflammatory response syndrome (SIRS) Systemic inflammatory response syndrome Sepsis-related Organ Failure Assessment (SOFA) Sequential sepsis-related organ failure assessment time-resolved amplified cryptate emission (TRACE) Time-resolved amplified cryptate emission WBC White blood cell
The real-world control group included fifty patients admitted to the Diagnostic and Therapeutic Medicine Department of Campus Bio-Medico of Rome for cardiac, kidney, liver, pulmonary and cancer diseases being responsible for a non-infectious related SIRS, qSOFA, or SOFA criteria positivity
SIRS criteria and qSOFA allowed a diagnosis in 97% and 96% of patients, respectively, in case of suspicion of sepsis outside ICU

Summary

Introduction

Abbreviations APACHE Acute Physiology and Chronic Health AUCs Areas under the curve CBC Complete blood counts CRP C-reactive protein ICU Intensive care unit IL-6 Interleukin 6 MR-proADM Mid-Regional pro-Adrenomedullin PCR Polymerase chain reaction PCT Procalcitonin PPV Positive predictive value qSOFA Quick ROC Receiver operating characteristic SIRS Systemic inflammatory response syndrome SOFA Sequential sepsis-related organ failure assessment TRACE Time-resolved amplified cryptate emission WBC White blood cell. In 2016, the Third international Consensus Conference (Sepsis-3) defined sepsis as a “life-threatening organ dysfunction caused by a dysregulated host response to infection” removing among diagnostic criteria the presence of the systemic inflammatory response syndrome (SIRS), previously used in the Sepsis-1 and Sepsis-2 C onsensus. The Third Consensus Conference (Sepsis-3) established that, in presence of suspected or documented infection, an increase of Sequential Sepsis-related Organ Failure Assessment (SOFA) score in intensive care unit (ICU) ≥ 2 from baseline have to be considered diagnostic for sepsis. The identification of the microbiological cause of sepsis is achieved in less than 50% of patients and only 30% of bacteremia are microbiologically d ocumented

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