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
Carlota Clemente1, Manuel Enrique Fuentes Ferrer2, Dolores Ortega Heredia3, Agustín Julián Jiménez4, Francisco Javier Martín-Sánchez1,5, Juan González del Castillo1,5
Objective.
To determine whether combining biomarkers of inflammatory response and clinical scales can improve risk stratification of patients with suspected infection in a hospital emergency department (ED).
Methods.
Prospective observational study of ED patients treated for infections. We collected the following information on arrival: demographic and baseline clinical data, comorbidities, the focus of infection, and values for the following inflammatory biomarkers: leukocyte counts, and C-reactive protein, procalcitonin, and midregional proadrenomedullin (MR-proADM) concentrations. Scores on the following clinical scales were recorded based on the variables gathered: the SIRS (Systemic Inflammatory Response Syndrome) criteria, the qSOFA (Quick Sequential Organ Failure Assessment), and the NEWS (National Early Warning Score). The main outcome was a composite measure that included 30-day death or need for intensive care unit (ICU) admission.
Results.
A total of 473 patients with a mean (SD) age of 70.3 (19.2) years were included. The majority were men (257, 54.3%). Thirty-one (6.6%) died within 30 days and 16 (3.4%) were admitted to the ICU. The composite outcome (death or ICU admission) occurred in 45 patients (9.5%). The MR-proADM concentration, with an area under the receiver operating characteristic curve of 0.739 (95% CI, 0671-0.809) was a better predictor than the other biomarkers or clinical scales, although the differences between MR-proADM and either lactate concentration or the NEWS were not significant in the comparisons (P = .064). Combining the MR-proADM concentration with any of the scales did not significantly improve risk prediction.
Conclusions.
Risk stratification of patients with infection is a key part of ED decision-making. MR-proADM concentration is superior to other biomarkers and clinical prediction scales for predicting short-term prognosis in the ED. Combining MR-proADM measurement with other scales or measures does not improve the yield.
