Journal Article

Prognostic performance of endothelial biomarkers to early predict clinical deterioration of patients with suspected bacterial infection and sepsis admitted to the emergency department

Khalil, Takun, Duconge Antoine, Measso Sabrina, Tazarourte Karim, Jacquet Landry, Douplat Marion, Chapelle-Petit, Nathalie, Pachot Alexandre, Nicol Amélie, Barbier, Laurence, Textoris Julien, Gissot Valérie, Marie-Angélique, Cazalis, Anoot Caroline, Pierre-François, Laterre, Dumas, Florence, Claire Montini Anne, Magnan, Julie, Verschuren Franck, Evrard, Bruno, Remize Jacques, Frey Jérome, Delaroche Marine, Maignan Maxime, Sebbane Mustapha, Mehrsa, Koukabi, Pancher Agathe, Colonna Anaïs, Vignon Philippe, Fabry Manon, Dupeux Olivier, Kaiser, Karine, Dalle Ludovic, Vallejo, Christine, Lambert, Yves, Jacquin, Laurent, Blein Sophie, Bruno, François, Chekaoui Abdel, Bertrand, Lionel, Thibault, Desmettre, Viglino Damien, Jardin François, Daix, Thomas, Desachy Arnaud, Laribi Said, Goudelin Marine, Lafon, Thomas, Laure Fedou Anne

2020

Overview

BackgroundThe objective of this study was to evaluate the ability of endothelial biomarkers to early predict clinical deterioration of patients admitted to the emergency department (ED) with a suspected sepsis. This was a prospective, multicentre, international study conducted in EDs. Adult patients with suspected acute bacterial infection and sepsis were enrolled but only those with confirmed infection were analysed. The kinetics of biomarkers and organ dysfunction were collected at T0, T6 and T24 hours after ED admission to assess prognostic performances of sVEGFR2, suPAR and procalcitonin (PCT). The primary outcome was the deterioration within 72 h and was defined as a composite of relevant outcomes such as death, intensive care unit admission and/or SOFA score increase validated by an independent adjudication committee.ResultsAfter adjudication of 602 patients, 462 were analysed including 124 who deteriorated (27%). On admission, those who deteriorated were significantly older (73 [60–82] vs 63 [45–78] y-o, p < 0.001) and presented significantly higher SOFA scores (2.15 ± 1.61 vs 1.56 ± 1.40, p = 0.003). At T0, sVEGFR2 (5794 [5026–6788] vs 6681 [5516–8059], p < 0.0001), suPAR (6.04 [4.42–8.85] vs 4.68 [3.50–6.43], p < 0.0001) and PCT (7.8 ± 25.0 vs 5.4 ± 17.9 ng/mL, p = 0.001) were associated with clinical deterioration. In multivariate analysis, low sVEGFR2 expression and high suPAR and PCT levels were significantly associated with early deterioration, independently of confounding parameters (sVEGFR2, OR = 1.53 [1.07–2.23], p < 0.001; suPAR, OR = 1.57 [1.21–2.07], p = 0.003; PCT, OR = 1.10 [1.04–1.17], p = 0.0019). Combination of sVEGFR2 and suPAR had the best prognostic performance (AUC = 0.7 [0.65–0.75]) compared to clinical or biological variables.ConclusionssVEGFR2, either alone or combined with suPAR, seems of interest to predict deterioration of patients with suspected bacterial acute infection upon ED admission and could help front-line physicians in the triage process.

• Publisher: Springer Nature B.V
• Subject: Bacterial infections / Biomarkers / Clinical deterioration / Infections / Intensive care / Medical prognosis / Sepsis / Vital signs