Predicting mortality in adult patients with sepsis in the emergency department by using combinations of biomarkers and clinical scoring systems: a systematic review

BMC Emergency Medicine

Christian Ramakers¹  Tjebbe Hagenaars²  Kirby Tong-Minh²  Iris Welten²  Yuri van der Does²  Diederik Gommers³  Henrik Endeman³  Eric van Gorp⁴ 

[1] Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, the Netherlands;Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, Postbus 2040, 3000, Rotterdam, CA, The Netherlands;Department of Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands;Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands;Department of Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands;

关键词: Sepsis;    Biomarkers;    Emergency department;    Prediction model;   

DOI  :  10.1186/s12873-021-00461-z

来源: Springer

【 摘 要 】

BackgroundSepsis can be detected in an early stage in the emergency department (ED) by biomarkers and clinical scoring systems. A combination of multiple biomarkers or biomarker with clinical scoring system might result in a higher predictive value on mortality. The goal of this systematic review is to evaluate the available literature on combinations of biomarkers and clinical scoring systems on 1-month mortality in patients with sepsis in the ED.MethodsWe performed a systematic search using MEDLINE, EMBASE and Google Scholar. Articles were included if they evaluated at least one biomarker combined with another biomarker or clinical scoring system and reported the prognostic accuracy on 28 or 30 day mortality by area under the curve (AUC) in patients with sepsis. We did not define biomarker cut-off values in advance.ResultsWe included 18 articles in which a total of 35 combinations of biomarkers and clinical scoring systems were studied, of which 33 unique combinations. In total, seven different clinical scoring systems and 21 different biomarkers were investigated. The combination of procalcitonin (PCT), lactate, interleukin-6 (IL-6) and Simplified Acute Physiology Score-2 (SAPS-2) resulted in the highest AUC on 1-month mortality.ConclusionThe studies we found in this systematic review were too heterogeneous to conclude that a certain combination it should be used in the ED to predict 1-month mortality in patients with sepsis. Future studies should focus on clinical scoring systems which require a limited amount of clinical parameters, such as the qSOFA score in combination with a biomarker that is already routinely available in the ED.

【 授权许可】

CC BY