Abstract
Background
Severe infections play an important role in the emergency department (ED) and early risk stratification is essential. We compared the prognostic value of APACHE II, SOFA, and MEDS scores, and the biomarkers C-reactive protein (CRP), procalcitonin (PCT), and interleukin 6 (IL-6).
Methods
We performed a prospective observational study. Patients aged 18 years or older with a severe infection, from whom blood cultures were taken, were included.
Results
Two hundred and eleven patients were included. The 30-day mortality rate was 8.5%. All scores and biomarkers showed significant area under the curve (AUC) values of receiver operating characteristic curve analysis for death within 30 days: 0.801 for APACHE II, 0.785 for MEDS, 0.708 for SOFA, 0.693 for CRP, 0.651 for PCT, and 0.716 for IL-6. For treatment in an ICU and need for mechanical ventilation, these parameters had significant AUC values, too. For renal replacement therapy, only APACHE II, SOFA, and PCT showed significant AUC values. According to the trend observed, the AUC values were highest for the APACHE II score.
Conclusions
All investigated parameters have a predictive value in patients with an infection in the ED. According to the trend observed, the APACHE II score seems to have the best discriminative power. Use of the APACHE II score already at the time of admission to the ED may be useful for stratifying patients at risk for ICU treatment, thereby using the same score in the ED and the ICU.
Zusammenfassung
Hintergrund
Schwere Infektionen sind häufige Krankheitsbilder in Notaufnahmen (NA), und frühe Risikoeinschätzung ist essenziell. Wir haben den prognostischen Wert der Scores APACHE II, SOFA und MEDS sowie der Biomarker C-reaktives Protein (CRP), Interleukin 6 (IL-6) und Procalcitonin (PCT) verglichen.
Methoden
Teilnehmer an der prospektiven Beobachtungsstudie waren erwachsene Patienten mit schwerer Infektion, bei denen Blutkulturen abgenommen wurden.
Ergebnisse
Es nahmen 211 Patienten an der Studie teil. Die 30-Tage-Mortalität betrug 8,5%. Alle Scores und Biomarker hatten signifikante Area-under-the-curve(AUC)-Werte von Receiver-operating-characteristic-curve-Analysen für Tod innerhalb von 30 Tagen: 0,801 für APACHE II, 0,785 für MEDS, 0,708 für SOFA, 0,693 für CRP, 0,651 für PCT, 0,716 für IL-6. Bezüglich der Notwendigkeit von Intensivtherapie und Beatmung hatten diese Parameter ebenfalls signifikante AUC-Werte. Für die Dialysebehandlung zeigten nur APACHE-II- und SOFA-Score sowie PCT signifikante AUC-Werte. Tendenziell hatte der APACHE-II-Score die höchsten Werte.
Schlussfolgerungen
Alle untersuchten Parameter sind von prognostischem Wert bei Patienten mit Infektionen in der NA. Der APACHE-II-Score scheint die beste Aussagekraft zu haben. Daher könnte es sinnvoll sein, den APACHE-II-Score bereits in der NA einzusetzen, damit im Fall einer Intensivtherapie der gleiche Score wie auf der Intensivstation benutzt würde.
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Limitations of the study
Our study has some limitations. It was a single-center study with a relatively low number of patients.
Acknowledgments
The authors acknowledge the staff of our ED, for contributing to our work. We thank Dr. Heider and the staff of the laboratory of our hospital for analyses as well as Professor Dr. Kekulé, Dr. Oehme, Dr. Hofmann, Dr. Wilhelms, and the staff from the Institute of Medical Microbiology for the microbiological analyses. We thank Dr. Lautenschläger, Institute for Medical Epidemiology, Biometrics and Computer Science, for statistical advice. On behalf of all the authors, the corresponding author states that there are no conflicts of interest.
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Wilhelm, J., Hettwer, S., Hammer, D. et al. Outcome prediction using clinical scores and biomarkers in patients with presumed severe infection in the emergency department. Med Klin Intensivmed Notfmed 107, 558–563 (2012). https://doi.org/10.1007/s00063-012-0147-5
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DOI: https://doi.org/10.1007/s00063-012-0147-5