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Open Access 01-12-2020 | Septicemia | Research

Prognostic performance of endothelial biomarkers to early predict clinical deterioration of patients with suspected bacterial infection and sepsis admitted to the emergency department

Authors: Thomas Lafon, Marie-Angélique Cazalis, Christine Vallejo, Karim Tazarourte, Sophie Blein, Alexandre Pachot, Pierre-François Laterre, Said Laribi, Bruno François, the TRIAGE study group

Published in: Annals of Intensive Care | Issue 1/2020

Abstract

Background

The objective of this study was to evaluate the ability of endothelial biomarkers to early predict clinical deterioration of patients admitted to the emergency department (ED) with a suspected sepsis. This was a prospective, multicentre, international study conducted in EDs. Adult patients with suspected acute bacterial infection and sepsis were enrolled but only those with confirmed infection were analysed. The kinetics of biomarkers and organ dysfunction were collected at T0, T6 and T24 hours after ED admission to assess prognostic performances of sVEGFR2, suPAR and procalcitonin (PCT). The primary outcome was the deterioration within 72 h and was defined as a composite of relevant outcomes such as death, intensive care unit admission and/or SOFA score increase validated by an independent adjudication committee.

Results

After adjudication of 602 patients, 462 were analysed including 124 who deteriorated (27%). On admission, those who deteriorated were significantly older (73 [60–82] vs 63 [45–78] y-o, p < 0.001) and presented significantly higher SOFA scores (2.15 ± 1.61 vs 1.56 ± 1.40, p = 0.003). At T0, sVEGFR2 (5794 [5026–6788] vs 6681 [5516–8059], p < 0.0001), suPAR (6.04 [4.42–8.85] vs 4.68 [3.50–6.43], p < 0.0001) and PCT (7.8 ± 25.0 vs 5.4 ± 17.9 ng/mL, p = 0.001) were associated with clinical deterioration. In multivariate analysis, low sVEGFR2 expression and high suPAR and PCT levels were significantly associated with early deterioration, independently of confounding parameters (sVEGFR2, OR = 1.53 [1.07–2.23], p < 0.001; suPAR, OR = 1.57 [1.21–2.07], p = 0.003; PCT, OR = 1.10 [1.04–1.17], p = 0.0019). Combination of sVEGFR2 and suPAR had the best prognostic performance (AUC = 0.7 [0.65–0.75]) compared to clinical or biological variables.

Conclusions

sVEGFR2, either alone or combined with suPAR, seems of interest to predict deterioration of patients with suspected bacterial acute infection upon ED admission and could help front-line physicians in the triage process.

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Title: Prognostic performance of endothelial biomarkers to early predict clinical deterioration of patients with suspected bacterial infection and sepsis admitted to the emergency department
Authors: Thomas Lafon
Marie-Angélique Cazalis
Christine Vallejo
Karim Tazarourte
Sophie Blein
Alexandre Pachot
Pierre-François Laterre
Said Laribi
Bruno François
the TRIAGE study group
Publication date: 01-12-2020
Publisher: Springer International Publishing
Keywords: Septicemia
Septicemia
Biomarkers
Published in: Annals of Intensive Care / Issue 1/2020
Electronic ISSN: 2110-5820
DOI: https://doi.org/10.1186/s13613-020-00729-w

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Prognostic performance of endothelial biomarkers to early predict clinical deterioration of patients with suspected bacterial infection and sepsis admitted to the emergency department

Abstract

Background

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Results

Conclusions

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