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Early Identification of Disease Progression in Patients with Suspected Infection Presenting to the ED

Early Identification of Disease Progression in Patients with Suspected Infection Presenting to the ED

In patients presenting to the emergency department (ED) with a suspected infection, the blood biomarker MR-proADM could most accurately identify the likelihood of further disease progression. Incorporation into an early sepsis management protocol may therefore aid rapid decision-making in order to either initiate, escalate or intensify early treatment strategies, or identify patients suitable for safe out-patient treatment.

1,175 derivation and 896 validation patients were analysed with respective 28-day mortality rates of 7.1% and 5.0%, and hospitalization rates of 77.9% and 76.2%. MR-proADM showed greatest accuracy in predicting 28-day mortality and hospitalization requirement across both cohorts.

Patient subgroups with high MR-proADM concentrations (≥ 1.54 nmol/L) and low biomarker (PCT < 0.25 ng/mL, lactate < 2.0 mmol/L or CRP < 67 mg/L) or clinical score (SOFA < 2 points, qSOFA < 2 points, NEWS < 4 points or CRB-65 < 2 points) values were characterized by a significantly longer length of hospitalization (p < 0.001), rate of ICU admission (p < 0.001), elevated mortality risk and a greater number of disease progression events (p < 0.001), compared to similar subgroups with low MR-proADM concentrations. Disease progression was identified using a composite endpoint of 28-day mortality, ICU admission and hospitalization > 10 days.

CriticalCare.news
February 8, 2020

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