Abstract
BackgroundSepsis 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.MethodsWe 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.ResultsWe 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.ConclusionThe 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.
Highlights
Sepsis can be detected in an early stage in the emergency department (ED) by biomarkers and clinical scoring systems
In the 18 articles that were included in this systematic review, a total of 35 combinations of biomarkers and clinical scoring systems were studied of which 33 unique combinations
In this systematic review we investigated the combinations of both biomarkers and clinical scoring systems with biomarkers to predict 1-month mortality in patients with sepsis
Summary
Sepsis can be detected in an early stage in the emergency department (ED) by biomarkers and clinical scoring systems. 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. Detection of sepsis is essential to timely start appropriate treatment [2, 3]. In patients with a suspected infection, is often undiagnosed, causing a delay in treatment and increased mortality [4, 5]. The emergency department (ED) is often the first setting during hospital stay where patients with a suspected infection are systematically evaluated, where early stages of sepsis can be detected. Identifying patients in the ED with a high risk of mortality is important, to start antibiotic treatment early, and to decide if patients require admission, high level care and monitoring
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