| Abstract | Objectives: This study aimed to test the sensitivity (true positive vs false negatives) of various diagnostic tools (SIRS, NEWS2 and qSOFA) and laboratory parameters (LAC, PCT, CRP) in detecting sepsis/septic shock (S/SS) at ICU admission. An additional goal was to assess prognostic value of detection tools in predicting overall mortality.
Subjects and methods: A total of 52 patients with S/SS were enrolled into this retrospectively conducted study, 32 (61.54%) had an end point diagnosis of sepsis, while 20 (38.46%) had septic shock. Overall, there was a mortality rate of 43.3%. Stratification scores were determined and further analyzed using MedCalc online resources and MedCalc for windows, respectively. Biomarkers (CRP, PCT and LAC) and other biochemical parameters were determined by standard laboratory procedures.
Results: The sensitivities for the detection of S/SS were SIRS=61.90% (95% CI 45.64 -76.43), NEWS2=82.35% (95% CI 69.13- 91.60) and qSOFA=36.00% (95% CI 23.62 – 51.04). NEWS2 had a greater sensitivity than both SIRS (82.35% vs. 61.90, P=0.0206) and qSOFA (82.35% vs. 36%, P<0.0001). There were no statistically significant differences in predicting S/SS mortality found amongst stratification scores. In terms of biomarkers, CRP was the most sensitive (90.38%, 95%CI 78.97-96.80) in identifying sepsis/septic shock, outperforming PCT (71.43%, 95% CI 53.7-85.36) and lactate (44.9%, 95% CI 30.67-69.77)
Conclusion: This study confirmed that the NEWS2 is significantly more sensitive than SIRS and qSOFA in detecting sepsis and septic shock at ICU admission. No statistical significance was found for the prediction of mortality. Furthermore, regarding sepsis biomarkers, CRP demonstrated greater sensitivity in identifying S/SS, than PCT and LAC. Further studies are needed to clarify the combined roles of detection tools and biomarkers for the early identification of S/SS. |
| Abstract (croatian) | Cilj: utvrđivanja osjetljivosti (tj. vjerojatnosti pozitivnog nalaza u bolesnih) različitih dijagnostičkih testova u bolesnika sa sepsom/septičkim šokom. Testirani su testovi probira (SIRS, NEWS 2 i qSOFA), kao i određeni laboratorijski parametri (laktati, prokalcitonin I C-reaktivni protein) kod prijama u jedinicu intenzivnog liječenja. Dodatni cilj je bio procjena prognostičke vrijednosti testova probira u predviđanju ukupne smrtnosti.
Bolesnici i metode: U ovo retrospektivno istrazivanje uklucena su ukupno 52 bolesnika sa S / SS uključena su u ovo retrospektivno provedeno istraživanje, njih 32 (61,54%) je imalo zavrsnu dijagnozu sepse, dok je njih 20 (38,46%) imalo dijagnozu septički šok. Sveukupno, stopa smrtnosti za sve bolesnike iznosila je 43,3%. Rezultati testova probira su analizirani pomoću mrežnih resursa MedCalc i MedCalc za Windows. Biomarkeri (CRP, PCT i LAC) i drugi biokemijski parametri određivani su standardnim laboratorijskim postupcima.
Rezultati: Osjetljivost na otkrivanje S / SS bila je SIRS = 61,90% (95% CI 45,64 -76,43), NEWS2 = 82,35% (95% CI 69,13 - 91,60) i qSOFA = 36,00% (95% CI 23,62 - 51,04) , NEWS2 imao je veću osjetljivost od SIRS-a (82,35% nasuprot 61,90, P = 0,0206) i qSOFA (82,35% nasuprot 36%, P <0,0001). Nije bilo statistički značajnih razlika u predviđanju S / SS smrtnosti pronađenih među tri testa probira. U pogledu biomarkera, CRP je bio najosjetljiviji (90,38%, 95% CI 78,97-96,80) u identificiranju sepse / septičkog šoka, a potom slijede PCT (71,43%, 95% CI 53,7-85,36) i laktati (44,9%, 95% CI 30,67 - 69,77)
Zaključak: Ova studija potvrdila je da je NEWS2 značajno osjetljiviji test probira od SIRS-a i qSOFA u svrhu otkrivanja sepse i septičkog šoka prilikom prijema u JIL. Nije pronađena statistički značajna razlika među testovima glede predviđanja smrtnosti. Nadalje, što se tiče biomarkera za sepsu, CRP je u ovoj studiji pokazao veću osjetljivost u identificiranju S / SS, nego PCT i LAC. Potrebne su daljnje studije kako bi se razjasnila kombinirana uloga raznih “screening” testova i biomarkera za ranu identifikaciju S / SS. |
