Mortality In Emergency Department Sepsis Score Research Articles

Development and Validation of a Rapid and Efficient Prognostic Scoring System for Sepsis Based on Oxygenation Index, Lactate and Glasgow Coma Scale.

To develop a concise scoring system for efficient and rapid assessment of sepsis prognosis applicable to emergency departments. This was a single-center retrospective cohort study of patients with sepsis. In this study, a new scoring system (oxygenation index, lactate, and Glasgow coma scale: GOL) was developed through a derivation group, and then the GOL was validated using a validation group. Multivariate logistic regression analysis was performed to investigate the relationship between GOL and 28-day adverse outcomes. The GOL was compared with the previous scoring system using receiver operating characteristic curves (ROC) and decision analysis curves. The endpoints of this study were mortality, mechanical ventilation (MV), and admission to the intensive care unit (AICU). 608 patients were included in the derivation group and 213 patients in the validation group, with 131 and 42 deaths, respectively. In the validation group, lactate (Lac), oxygenation index (PaO2/FiO2), and Glasgow coma scale score (GCS), the three best performers in predicting 28-day mortality from receiver operating characteristic curves, were used to construct the GOL. The higher the GOL score, the higher the incidence of death, MV and AICU within 28 days. Multifactorial logistic regression analysis showed that when the GOL was greater than 1, it was an independent risk factor for 28-day mortality, MV, and AICU. In predicting 28-day mortality, GOL was superior to the quick Sequential Organ Failure Assessment (qSOFA), Mortality in Emergency Department Sepsis Score (MEDS), Systemic Inflammatory Response Syndrome Score (SIRS), and Modified Early Warning Score (MEWS), and was comparable to the Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA). The GOL is a simple, rapid, and accurate method for early identification of patients at increased risk of in-hospital death from sepsis.

Effects of vitamin D insufficiency on sepsis severity and risk of hospitalisation in emergency department patients: a cross-sectional study

ObjectiveTo evaluate the association of 25-hydroxyvitamin D (25(OH)D) level on sepsis severity and risk of hospitalisation in emergency department (ED) septic patients when categorised as vitamin D insufficiency according to...

Predictive Value of Combination of Procalcitonin and Predisposition, Infection, Response, and Organ Dysfunction (PIRO) System in Septic Patients with Positive Blood Cultures in the Emergency Department.

PurposeProcalcitonin and predisposition, infection, response, and organ dysfunction (PIRO) system have high predictive value for the prognosis of critically ill patients. There are few studies on the predictive value of patients with positive blood cultures. The aim of the study was to evaluate risk stratification and sepsis-related mortality in patients with positive blood cultures via procalcitonin (PCT) combined with the PIRO system in emergency departments (ED).MethodsA total of 1074 patients with positive blood cultures were admitted to Beijing Chao-Yang Hospital ED from December 2017 to October 2020. Their serum PCT was recorded, along with a Sequential Organ Failure Assessment (SOFA) score, Mortality in Emergency Department Sepsis (MEDS) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and PIRO score to predict the prognosis of septic patients with positive blood culture in terms of ICU (intensive care unit) admission, multiple organ dysfunction syndrome (MODS) development, and 28-day mortality. Receiver operating characteristic (ROC) curves and logistic regression analysis were used to assess the prognostic value of the scoring systems.ResultsA total of 978 patients met the inclusion criteria. PCT, MEDS, APACHE II, and PIRO scores were found to independently predict ICU-admission, MODS development, and 28-day mortality (P<0.05), whereas SOFA did not. The AUC values of the PCT, MEDS, APACHE II, and PIRO scores for ICU-admission were 0.620, 0.740, 0.780, and 0.751, respectively. In the prediction of 28-day mortality, the AUC values of PCT, MEDS, APACHE II, and PIRO were 0.782, 0.745, 0.805, and 0.831, respectively. The AUC values combined PCT and PIRO system in predicting MODS and 28-day mortality were better than when predicting ICU-admission.ConclusionThis study indicates that PCT combined with the PIRO scoring system has a higher predictive value and is superior in predicting MODS and 28-day mortality in septic patients with positive blood cultures.

An Evaluation of the Predictive Value of Sepsis Patient Evaluation in the Emergency Department (SPEED) Score in Estimating 28-Day Mortality Among Patients With Sepsis Presenting to the Emergency Department: A Prospective Observational Study.

Background and objectiveSepsis is a life-threatening medical emergency and a significant cause of mortality. Risk stratification scores for sepsis can be unsuitable for use in the emergency department (ED) due to their complexity, and an appropriate solution has yet to be found. In this study, the predictive value of the Sepsis Patient Evaluation in the Emergency Department (SPEED) score in estimating 28-day mortality was assessed among patients with sepsis presenting to the ED, in order to determine its suitability as an efficient risk stratification system.Materials and methodsThis was a single-center, prospective observational study conducted at an urban tertiary care center. We included patients presenting to the ED with suspected or confirmed sepsis who met the inclusion and exclusion criteria of our study. The patients were evaluated with the following scoring systems on arrival: the SPEED score; Predisposition, Infection, Response, and Organ dysfunction (PIRO) score; and Mortality in Emergency Department Sepsis (MEDS) score; the patients were subsequently followed up on the 28th day to record the final outcomes with regard to mortality and discharge rates.ResultsThis study included 127 patients in total. The median age of the study population was 49 years, and the 28-day mortality rate was 50.4%. The area under the receiver operating characteristic (AUROC) curve for the SPEED score for predicting mortality was 0.899 (95% CI: 0.847-0.951). In comparison, the AUROC for MEDS and PIRO scores was 0.857 (95% CI: 0.793-0.92) and 0.895 (95% CI: 0.838-0.951), respectively. Based on the DeLong test, no significant difference was found in the diagnostic performances with respect to these scores.ConclusionThe SPEED score is a simple and handy parameter that can be used for the early and appropriate risk stratification of patients with sepsis in the ED.

120 Cardiopulmonary Ultrasound in Sepsis: A Pilot Study

Sepsis-induced cardiomyopathy (SICM) is a recognized and often reversible form of cardiac dysfunction in patients with sepsis. Few studies have assessed the utility of point-of-care ultrasound in the management of patients with sepsis, especially early in the disease course. The purpose of this study is to evaluate echocardiogram and lung ultrasound findings and correlation with clinical outcomes. This was a prospective, pilot study enrolling adult patients (>18 years) with sepsis at a single academic emergency department (ED). Patients were enrolled within one hour of sepsis onset, defined as the time at which our sepsis screening tool in the electronic medical record alerted the provider of potential and/or severe infection. Echocardiogram and lung ultrasounds were performed and reviewed by an ultrasound-fellowship trained member of the research team. Ultrasound findings included left ventricular (LV) function, right ventricular (RV) function, RV size, and presence of anterior thoracic B lines. Demographics, clinical outcomes, sepsis measures, and ultrasound findings were analyzed using descriptive statistics. Multivariate logistic regression was performed with variables chosen a priori and included: hyperdynamic LV function, reduced right ventricular (RV) function or abnormal RV size, inferior vena cava (IVC) collapsibility with respiration, > 5 B-lines on lung ultrasound (LUS), >1 pleural effusion on LUS, and Mortality in ED sepsis score. Primary outcomes were need for positive pressure ventilation (PPV) or vasopressors at 12 hours. In total, 92 patients were enrolled, including 43 patients with hyperdynamic LV function and 49 with normal/reduced LV function. 10 patients required vasopressor and 11 required PPV at 12 hours from the time of ED arrival. Demographics and sepsis management variables were well matched between groups, with the exception of supplemental oxygen use being more prevalent in the normal/reduced group (28 v. 11, p = 0.002). Hyperdynamic LV function did not correlate with vasopressor or PPV use at 12 hours (OR 2.51—95% CI 0.32-19.88 and OR 4.63—95% CI 0.37-57.24, respectively). Abnormal RV function or size, IVC collapsibility, and lung US findings did not demonstrate statistical significance (Table 1). In this small cohort of patients, hyperdynamic LV function did not correlate with need for vasopressors or PPV at 12 hours. However, abnormal RV size and >5 B-lines did trend towards significance for both primary outcomes. Future studies with a larger sample size are needed to better elucidate these findings.Table 1Multivariate Regression Analysis for primary outcomes.VariablePPV Use at 12HRVasopressor Use at 12HRORp95% CIORp95% CIHyperdynamic LV4.630.2330.37-57.242.510.3820.32-19.88RV Function- abnormalCannot Calculate0.0880.3430.00-13.38RV Size- abnormal1.380.8580.04-47.067.770.0810.78-77.70IVC Collapsible0.040.0600.00-1.150.140.1390.01-1.90>5 B-lines on LUS11.570.0530.96-138.720.200.2450.01-3.10>1 Pleural effusion on LUS0.060.1320.00-2.340.940.9570.11-8.41MEDS Score1.480.0051.13-1.951.400.0031.12-1.74 Open table in a new tab

Outcome prediction using the Mortality in Emergency Department Sepsis score combined with procalcitonin for influenza patients

BackgroundSevere influenza is often associated with bacterial coinfection and can trigger sepsis, which increases the severity, complexity and mortality of the disease. To determine an effective method for predicting 28-day mortality of emergency department (ED) patients with influenza, we investigated the Mortality in Emergency Department Sepsis (MEDS) score, procalcitonin (PCT) and other relevant biomarkers. MethodsWe conducted a retrospective, observational, monocentric study, and the endpoint was 28-day mortality. Independent predictors were identified and a new combination predictive model was created both by logistic regression, and the model was evaluated by a receiver operating characteristic (ROC) curve. ResultsA total of 364 consecutive ED admitted patients with influenza were enrolled and 45 patients died within 28 days. For predicting 28-day mortality, the MEDS score and PCT were independent predictors with adjusted odds ratio of 1.318 (95% CI 1.206–1.439) and 1.038 (95% CI 1.010–1.065), and with AUCs of 0.817 (95% CI 0.756–0.878) and 0.793 (95% CI 0.725–0.861), respectively. The new combination of the MEDS score with PCT significantly improved the efficacy for predicting 28-day mortality with an AUC of 0.857 (95% CI 0.809–0.905), and was superior to the SOFA score with an AUC of 0.837 (95% CI 0.779–0.894). ConclusionThe MEDS score and PCT, especially when combined, perform well for predicting mortality of ED admitted patients with influenza.

Sepsis patient evaluation emergency department (SPEED) score & mortality in emergency department sepsis (MEDS) score in predicting 28-day mortality of emergency sepsis patients

PurposeSepsis is a common acute life-threatening condition that emergency physicians routinely face. Diagnostic options within the Emergency Department (ED) are limited due to lack of infrastructure, consequently limiting the use of invasive hemodynamic monitoring or imaging tests. The mortality rate due to sepsis can be assessed via multiple scoring systems, for example, mortality in emergency department sepsis (MEDS) score and sepsis patient evaluation in the emergency department (SPEED) score, both of which quantify the variation of mortality rates according to clinical findings, laboratory data, or therapeutic interventions. This study aims to improve the management processes of sepsis patients by comparing SPEED score and MEDS score for predicting the 28-day mortality in cases of emergency sepsis. MethodsThe study is a cross-sectional, prospective study including 61 sepsis patients in ED in Suez Canal University Hospital, Egypt, from August 2017 to June 2018. Patients were selected by two steps: (1) suspected septic patients presenting with at least one of the following abnormal clinical findings: (a) body temperature higher than 38°C or lower than 36°C, (b) heart rate higher than 90 beats/min, (c) hyperventilation evidenced by respiratory rate higher than 20 breaths/min or PaCO2 lower than 32 mmHg, and (d) white blood cell count higher than 12,000/μL or lower than 4000/μL; (2) confirmed septic patients with at least a 2-point increase from the baseline total sequential organ failure assessment (SOFA) score following infection. Other inclusion criteria included adult patients with an age ≥18 years regardless of gender and those who had either systemic inflammatory response syndrome or suspected/confirmed infection. Patients were shortly follow-up for the 28-day mortality. Each patient was subject to SPEED score and MEDS score and then the results were compared to detect which of them was more effective in predicting outcome. The receiver operating characteristic curves were also done for MEDS and SPEED scores. ResultsAmong the 61 patients, 41 died with the mortality rate of 67.2%. The mortality rate increased with a higher SPEED and MEDS scores. Both SPEED and MEDS scores revealed significant difference between the survivors and nonsurvivors (p = 0.004 and p < 0.001, respectively), indicating that both the two systems are effective in predicting the 28-day mortality of sepsis patients. Thereafter, the receiver operating characteristic curves were plotted, which showed that SPEED was better than the MEDS score when applied to the complete study population with an area under the curve being 0.87 (0.788–0.963) as compared with 0.75 (0.634–0.876) for MEDS. Logistic regression analysis revealed that the best fitting predictor of 28-day mortality for sepsis patients was the SPEED scoring system. For every one unit increase in SPEED score, the odds of 28-day mortality increased by 37%. ConclusionSPEED score is more useful and accurate than MEDS score in predicting the 28-day mortality among sepsis patients. Therefore SPEED rather than MEDS should be more widely used in the ED for sepsis patients.

Validation of the mortality in emergency department sepsis (MEDS) score in a Singaporean cohort.

The emergency department (ED) serves as the first point of hospital contact for most septic patients. Early mortality risk stratification using a quick and accurate triage tool would have great value in guiding management. The mortality in emergency department sepsis (MEDS) score was developed to risk stratify patients presenting to the ED with suspected sepsis, and its performance in the literature has been promising. We report in this study the first utilization of the MEDS score in a Singaporean cohort.In this retrospective observational cohort study, adult patients presenting to the ED with suspected sepsis and fulfilling systemic inflammatory response syndrome (SIRS) criteria were recruited. Primary outcome was 30-day in-hospital mortality (IHM) and secondary outcome was 72-hour mortality. MEDS, acute physiology and chronic health evaluation II (APACHE II), and sequential organ failure assessment (SOFA) scores were compared for prediction of primary and secondary outcomes. Receiver operating characteristic (ROC) analysis was conducted to compare predictive performance.Of the 249 patients included in the study, 46 patients (18.5%) met 30-day IHM. MEDS score achieved an area under the ROC curve (AUC) of 0.87 (95% confidence interval [CI], 0.82-0.93), outperforming the APACHE II score (0.77, 95% CI 0.69-0.85) and SOFA score (0.78, 95% CI 0.71-0.85). On secondary analysis, MEDS score was superior to both APACHE II and SOFA scores in predicting 72-hour mortality, with AUC of 0.88 (95% CI 0.82-0.95), 0.81 (95% CI 0.72-0.89), and 0.79 (95% CI 0.71-0.87), respectively. In predicting 30-day IHM, MEDS score ≥12, APACHE II score ≥23, and SOFA score ≥5 performed at sensitivities of 76.1%, 67.4%, and 76.1%, and specificities of 83.3%, 73.9%, and 65.0%, respectively.The MEDS score performed well in its ability for mortality risk stratification in a Singaporean ED cohort.

Outcome prediction using the Mortality in Emergency Department Sepsis score combined with procalcitonin for influenza patients

BackgroundSevere influenza is often associated with bacterial coinfection and can trigger sepsis, which increases the severity, complexity and mortality of the disease. To determine an effective method for predicting 28-day mortality of emergency department (ED) patients with influenza, we investigated the Mortality in Emergency Department Sepsis (MEDS) score, procalcitonin (PCT) and other relevant biomarkers. MethodsWe conducted a retrospective, observational, monocentric study, and the endpoint was 28-day mortality. Independent predictors were identified and a new combination predictive model was created both by logistic regression, and the model was evaluated by a receiver operating characteristic (ROC) curve. ResultsA total of 364 consecutive ED admitted patients with influenza were enrolled and 45 patients died within 28 days. For predicting 28-day mortality, the MEDS score and PCT were independent predictors with adjusted odds ratio of 1.318 (95% CI 1.206–1.439) and 1.038 (95% CI 1.010–1.065), and with AUCs of 0.817 (95% CI 0.756–0.878) and 0.793 (95% CI 0.725–0.861), respectively. The new combination of the MEDS score with PCT significantly improved the efficacy for predicting 28-day mortality with an AUC of 0.857 (95% CI 0.809–0.905), and was superior to the SOFA score with an AUC of 0.837 (95% CI 0.779–0.894). ConclusionThe MEDS score and PCT, especially when combined, perform well for predicting mortality of ED admitted patients with influenza.

Validation of MEDS score in predicting short-term mortality of adults with community-onset bacteremia

BackgroundThe Mortality in Emergency Department Sepsis (MEDS) score can be used to stratify ED patients with suspected infections according to mortality risk. However, it has yet to be externally validated for patients having bloodstream infections. MethodsWe retrospectively computed clinical information for the MEDS score, Pitt bacteremia score (PBS), Charlson comorbidity index (CCI), and McCabe–Jackson comorbid classification (MJCC) for adults with community-onset bacteremia. The MEDS score was validated by the comparisons with the following scoring systems: the PBS, CCI, MJCC, PBS plus MJCC, and PBS plus CCI. We evaluated goodness-of-fit statistics and c-statistics as measures of model calibration and discrimination, respectively. ResultsOf 2328 adults, a good calibration for 28-day crude mortality was obtained only in the MEDS score and PBS plus MJCC; a higher c-statistic (0.870, P < 0.001) were achieved by the MEDS score, compared to the PBS, CCI MJCC, PBS plus MJCC, and PBS plus CCI. A high c-statistic was observed in two combinative scoring system: the PBS plus CCI (0.855, P < 0.001) and PBS plus MJCC (0.843, P < 0.001). According to the Kaplan–Meier curves, 28-day crude mortality significantly differed between patients with scores equal to or higher than selected cutoff values and those with scores lower than selected cutoff values: 10 in the MEDS score and 5 in the PBS plus MJCC, respectively. ConclusionThe MEDS score is an excellent predictor of short-term outcomes in patients with community-onset bacteremia because it provides estimates with higher calibration and discrimination than those of the other scoring systems.

Combining Heart Rate Variability with Disease Severity Score Variables for Mortality Risk Stratification in Septic Patients Presenting at the Emergency Department.

The emergency department (ED) serves as the first point of hospital contact for many septic patients, where risk-stratification would be invaluable. We devised a combination model incorporating demographic, clinical, and heart rate variability (HRV) parameters, alongside individual variables of the Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II (APACHE II), and Mortality in Emergency Department Sepsis (MEDS) scores for mortality risk-stratification. ED patients fulfilling systemic inflammatory response syndrome criteria were recruited. National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), quick SOFA (qSOFA), SOFA, APACHE II, and MEDS scores were calculated. For the prediction of 30-day in-hospital mortality, combination model performed with an area under the receiver operating characteristic curve of 0.91 (95% confidence interval (CI): 0.88–0.95), outperforming NEWS (0.70, 95% CI: 0.63–0.77), MEWS (0.61, 95% CI 0.53–0.69), qSOFA (0.70, 95% CI 0.63–0.77), SOFA (0.74, 95% CI: 0.67–0.80), APACHE II (0.76, 95% CI: 0.69–0.82), and MEDS scores (0.86, 95% CI: 0.81–0.90). The combination model had an optimal sensitivity and specificity of 91.4% (95% CI: 81.6–96.5%) and 77.9% (95% CI: 72.6–82.4%), respectively. A combination model incorporating clinical, HRV, and disease severity score variables showed superior predictive ability for the mortality risk-stratification of septic patients presenting at the ED.

Risk stratification and prognostic evaluation of endothelial cell-specific molecule1, von Willebrand factor, and a disintegrin-like and metalloprotease with thrombospondin type 1 motif for sepsis in the emergency department: An observational study.

This study evaluated endothelial cell-specific molecule1 (endocan), von Willebrand factor (vWF), and A disintegrin-like and metalloprotease with thrombospondin type 1 motif (ADAMTS-13), alone or in combination, in the risk stratification and prognosis prediction of patients with sepsis. Clinical data of 301 patients were prospectively analyzed, and divided into systemic inflammatory reaction syndrome, sepsis, severe sepsis, and septic shock groups. A total of 40 healthy individuals were studied as the control group. Endocan, vWF, ADAMTS-13, vWF/ADAMTS-13, and procalcitonin levels were measured, and Acute Physiology and Chronic Health Evaluation (APACHE II) score, Mortality in Emergency Department Sepsis (MEDS) score as well as Sequential Organ Failure Assessment (SOFA) score were calculated. The all-cause death or survival of each patient was recorded during the 28-day follow-up. The endocan, vWF, and vWF/ADAMTS-13 levels significantly increased in patients and were positively correlated with disease severity. On the first day of admission, MEDS score, ADAMTS-13, and vWF/AMAMTS-13 ratio were independent predictors for 28-day mortality from sepsis. Moreover, the combination of vWF/ADAMTS-13 ratio with MEDS score improved the accuracy in predicting the 28-day mortality from sepsis. On day 5, endocan, vWF, ADAMTS-13, and vWF/ADAMTS-13 ratio were independent predictors for the 28-day mortality from sepsis, while the combined use of endocan and vWF/ADAMTS-13 ratio improved the prognostic value of individual indicators. Endocan, vWF, ADAMTS-13, and vWF/ADAMTS-13 ratio are valuable in the risk stratification and prognostic evaluation of sepsis as novel biomarkers.

Surgical Delay is associated with Improved Survival in Patients with Hepatocellular Carcinoma

To evaluate the efficacy of soluble programmed death-1 (sPD-1) for risk stratification and prediction of 28-day mortality in patients with sepsis, we compared serum sPD-1 with procalcitonin (PCT), C-reactive protein (CRP), and the Mortality in Emergency Department Sepsis (MEDS) score.A total of 60 healthy volunteers and 595 emergency department (ED) patients were recruited for this prospective cohort study. According to the severity of their condition on ED arrival, the patients were allocated to the systemic inflammatory response syndrome group (130 cases), sepsis group (276 cases), severe sepsis group (121 cases), and septic shock group (68 cases). In addition, all patients with sepsis were also divided into the survivor group (349 cases) and nonsurvivor group (116 cases) according to the 28-day outcomes.When the severity of sepsis increased, the levels of sPD-1 gradually increased. The levels of sPD-1, PCT, CRP and the MEDS score were also higher in the nonsurvivor group compared to the survivor group. Logistic regression suggested that sPD-1, PCT, and the MEDS score were independent risk factors for 28-day mortality of patients with sepsis. Area under the curve (AUC) of sPD-1, PCT and the MEDS score for 28-day mortality was 0.725, 0.693, and 0.767, respectively, and the AUC was improved when all 3 factors were combined (0.843).Serum sPD-1 is positively correlated with the severity of sepsis, and it is valuable for risk stratification of patients and prediction of 28-day mortality. Combining sPD-1 with PCT and the MEDS score improves the prognostic evaluation.

Pro-BNP versus MEDS Score in Determining the Prognosis of Sepsis Patients; a Diagnostic Accuracy Study

Pro-brain natriuretic peptide (Pro-BNP) can act as an independent predictor of mortality in septic patients. This study aimed to compare the diagnostic accuracy of pro-BNP and Mortality in Emergency Department Sepsis (MEDS) score in this regard. This cross-sectional study was conducted on > 14 years old sepsis patients of an emergency department (ED), during 2 years. The level of Pro-BNP and MEDS score were measured for all eligible patients and considering one month mortality as reference, screening performance characteristics of the two tests were compared using SPSS 21 and STATS 11. 121 patients with the mean age of 75.87±11.82 years were studied (55.4% male). 85 (70.25%) patients had moderate to high probability of mortality according to MEDS score. The mean Pro-BNP levels of survivor and non-survivor patients were 489.69 ± 327.47 and 3954.98 ± 2717.85 pg/ml, respectively (p < 0.0001). Sensitivity and specificity of Pro-BNP (in 1000 pg/ml cut off) and MEDS score (in level 3) in prediction of 1-month mortality were 93.6 (83.7-97.9), 94.8 (84.7-98.6), 65.0 (51.9-76.3), and 98.2 (89.5-99.9), respectively. Area under the ROC curve of the two tests were 97.36 (95% CI: 92.92-94.48) and 92.31 (95% CI: 86.35-96.53), respectively (p = 0.0543). Pro-BNP and MEDS score both have excellent diagnostic accuracy in predicting 1-month mortality of sepsis patients. However, considering the higher sensitivity as well as availability and ease of calculation, it seems that Pro-BNP can be considered an appropriate tool for screening patients with high risk of mortality following sepsis in ED.

The risk stratification and prognostic evaluation of soluble programmed death-1 on patients with sepsis in emergency department

ObjectiveTo evaluate the efficacy of soluble programmed death-1 (sPD-1) for risk stratification and prediction of 28-day mortality in patients with sepsis, we compared serum sPD-1 with procalcitonin (PCT), C-reactive protein (CRP), and the Mortality in Emergency Department Sepsis (MEDS) score. MethodsA total of 60 healthy volunteers and 595 emergency department (ED) patients were recruited for this prospective cohort study. According to the severity of their condition on ED arrival, the patients were allocated to the systemic inflammatory response syndrome group (130 cases), sepsis group (276 cases), severe sepsis group (121 cases), and septic shock group (68 cases). In addition, all patients with sepsis were also divided into the survivor group (349 cases) and nonsurvivor group (116 cases) according to the 28-day outcomes. ResultsWhen the severity of sepsis increased, the levels of sPD-1 gradually increased. The levels of sPD-1, PCT, CRP and the MEDS score were also higher in the nonsurvivor group compared to the survivor group. Logistic regression suggested that sPD-1, PCT, and the MEDS score were independent risk factors for 28-day mortality of patients with sepsis. Area under the curve (AUC) of sPD-1, PCT and the MEDS score for 28-day mortality was 0.725, 0.693, and 0.767, respectively, and the AUC was improved when all 3 factors were combined (0.843). ConclusionSerum sPD-1 is positively correlated with the severity of sepsis, and it is valuable for risk stratification of patients and prediction of 28-day mortality. Combining sPD-1 with PCT and the MEDS score improves the prognostic evaluation.

Prognostic significance of C5a2 on polymorphonuclear neutrophil and C5a2intra/C5a2 ratio level for early sepsis in an ED

IntroductionThe current study was designed to evaluate the expression of the second C5a receptor (C5a2) on polymorphonuclear neutrophil and in the cytoplasm of polymorphonuclear neutrophils (C5a2intra) in patients with sepsis in the emergency department (ED) for risk stratification and mortality. MethodsConsecutive patients fulfilling the criteria for systemic inflammatory response syndrome (n = 357) were admitted to Beijing Chao-Yang Hospital ED between January 2015 and July 2015. They were enrolled to identify the expression of C5a2 and C5a2intra and categorized into the following 4 groups: systemic inflammatory response syndrome, sepsis, severe sepsis, and septic shock. ResultsWe report that the surface C5a2 decreased and the C5a2intra/C5a2 ratio level increased with sepsis severity. As independent predictors of 28-day mortality, the areas under the receiver operating characteristic curves of combination of C5a2 or C5a2intra/C5a2 ratio level and the Mortality in ED Sepsis score were significantly higher than that of procalcitonin alone in predicting 28-day mortality in septic patients. ConclusionThe C5a2 and the C5a2intra/C5a2 ratio levels are probably valuable for the risk stratification of sepsis and are associated with the mortality of early sepsis in the ED.

CLINICAL VALUE OF TWO SCORING SYSTEMS, C-REACTIVE PROTEIN AND LACTATE CLEARANCE IN PATIENTS WITH SEVERE SEPSIS AT THE EMERGENCY DEPARTMENT

Introduction: More recently the grading system of sepsis was modified to include severe sepsis, septic shock, and refractory septic shock. Several indexes were found to be significantly related to short-term clinical outcome; as sequential organ failure assessment score (SOFA) and the mortality in emergency department sepsis (MEDS) score. Methods: Observational cohort study with prospective data collection. Severity of sepsis was assessed according to SOFA score, MEDS score. C-reactive protein (CRP) and 6 hours lactate clearance were measured. The outcome of patients was noticed according to the detected SOFA score, MEDS score, CRP, and lactate clearance levels in the survivors and non-survivors as well as their correlation with the severity of the disease. Results: Fifty patients with age range from 20 to 92 years. The mortality rate was 24% (12 patients). Six hours lactate clearance mean value was 21.04 ± 9.48%. Mean SOFA score at presentation was 6.56 ± 2.99 while after 72 hours, it was 5.28 ± 3.94. Mean MEDS score was 2.72. Six hours lactate clearance was significantly lower among the dead cases. MEDS score was significantly higher among the mortality cases. SOFA score whether measured at admission or after 72 hours and MEDS score were significantly higher among the dead cases. Both delta SOFA score and 6 hour lactate clearance were found to have the highest predictive characteristics with 100% sensitivity and specificity. There was statistically significant difference between area under the curve of SOFA 72 hours and 6 hours-lactate clearance when compared to CRP area under the curve. Conclusion: Both delta SOFA score and six hour lactate clearance had the highest predictive characteristics with 100% sensitivity and specificity.

Prognostic significance of the angiopoietin-2/angiopoietin-1 and angiopoietin-1/Tie-2 ratios for early sepsis in an emergency department.

IntroductionThis study was performed to assess the early diagnostic, risk stratification, and prognostic value of the angiopoietin-2/angiopoietin-1 ratio (Ang-2/Ang-1) and angiopoietin-1/tyrosine kinase with immunoglobulin-like loop epidermal growth factor homology domain 2 ratio (Ang-1/Tie-2) and to compare these factors with procalcitonin (PCT) and the Mortality in Emergency Department Sepsis (MEDS) score in patients with early sepsis in the emergency department (ED).MethodsConsecutive patients with sepsis (n = 440) were enrolled in this study. They fulfilled the systemic inflammatory response syndrome (SIRS) criteria and were admitted to the ED of Beijing Chao-yang Hospital between August 2014 and February 2015. The control group consisted of 55 healthy blood donors. The patients were categorized into four groups: SIRS, sepsis, severe sepsis, and septic shock. Serum Ang-1, Ang-2, Tie-2, and PCT were measured, and the MEDS score was calculated upon ED arrival. The prognostic values of Ang-2/Ang-1, Ang-1/Tie-2, Ang-1, Ang-2, and Tie-2 were compared with the PCT and MEDS scores. All patients were followed for 28 days.ResultsUpon admission, the median levels of the serum Ang-2 level and Ang-2/Ang-1 ratio increased and the serum Ang-1 levels and Ang-1/Tie-2 ratios decreased with the severity of sepsis. The areas under the receiver operating characteristic curves of the Ang-2/Ang-1 and Ang-1/Tie-2 ratios were greater than those of the Ang-1, Ang-2, and PCT levels and MEDS scores in the diagnosis and prediction of 28-day mortality due to sepsis. Ang-2/Ang-1 was significantly higher and Ang-1/Tie-2 was significantly lower in nonsurvivors than in survivors at the 28-day follow-up examination. Ang-2/Ang-1, Ang-1/Tie-2, and MEDS score were found to be independent predictors of 28-day mortality in patients with sepsis. The levels of serum Ang-1, Ang-2, and Tie-2 were positively correlated with each other. The ratios of Ang-2/Ang-1 and Ang-1/Tie-2 were positively and negatively correlated, respectively, with the MEDS score in every septic group.ConclusionsThe Ang-2/Ang-1 and Ang-1/Tie-2 ratios are valuable for risk stratification in patients with sepsis and are associated with the poor clinical outcome of early sepsis in the ED.

Clinical Performance of a New Soluble CD14-Subtype Immunochromatographic Test for Whole Blood Compared with Chemiluminescent Enzyme Immunoassay: Use of Quantitative Soluble CD14-Subtype Immunochromatographic Tests for the Diagnosis of Sepsis.

We previously reported that a soluble CD14-subtype (sCD14-ST) immunochromatographic test (ICT) for plasma is more convenient than chemiluminescent enzyme immunoassay (CLEIA), but plasma separation makes bedside measurements difficult. We developed a new sCD14-ST ICT for whole blood and investigated whether quantitative determinations of sCD14-ST by ICT were useful for diagnosing sepsis and severe sepsis/septic shock. We studied 20 patients who fulfilled two or more systemic inflammatory response syndrome (SIRS) criteria and 32 patients who had been diagnosed with sepsis or severe sepsis/septic shock. Whole blood was collected on day 0 (on admission) and day 7, and the sCD14-ST concentration was quantitatively measured by CLEIA and ICT for whole blood. The patients’ Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA), and Mortality in Emergency Department Sepsis (MEDS) scores were also calculated. The cut-off values obtained by the quantitative measurements made by ICT were 464.5 pg/mL for sepsis and 762.7 pg/mL for severe sepsis/septic shock (P < 0.0001). A Bland–Altman plot showed that no fixed bias or proportional bias was detected between CLEIA and quantitative ICT for whole blood. sCD14-ST concentrations were significantly correlated with APACHE II, SOFA, and MEDS scores (P < 0.0001). These results suggest that the new sCD14-ST ICT for whole blood may be a useful tool for the convenient, rapid bedside diagnosis and treatment of sepsis.

Value of plasma neutrophil gelatinase-associated lipocalin in predicting the mortality of patients with sepsis at the emergency department

BackgroundSepsis is a major cause of morbidity and mortality in the emergency department. This study aimed to evaluate the assessment of severity of sepsis by and prognostic value of plasma neutrophil gelatinase-associated lipocalin (NGAL) compared with other widely used biological markers of inflammation in patients with sepsis. MethodsNGAL, procalcitonin, and C-reactive protein values were measured in 470 patients with suspected sepsis, and the Mortality in Emergency Department Sepsis (MEDS) score was obtained for all enrolled subjects, who were followed for up to 28days. ResultsThe median plasma NGAL value was increased with sepsis severity according to the MEDS score. The plasma NGAL value was higher in nonsurvivors than in survivors. The area under the receiver operating characteristic curve of NGAL (0.797) was greater than that of procalcitonin (0.599) and MEDS score (0.774) in predicting 28-day hospital mortality. Multivariable logistic regression found that the plasma NGAL value was an independent predictor for hospital mortality in patients with sepsis. The plasma NGAL values were positively correlated with C-reactive protein and procalcitonin levels, and MEDS scores. ConclusionsPlasma NGAL is a valuable biological marker in the assessment of severity and prediction of prognosis of patients with sepsis in the emergency department.