Format

Send to

Choose Destination
Enferm Infecc Microbiol Clin. 2019 Jan;37(1):11-18. doi: 10.1016/j.eimc.2017.11.017. Epub 2017 Dec 27.

Prognostic power of biomarkers for short-term mortality in the elderly patients seen in Emergency Departments due to infections.

[Article in English, Spanish]

Author information

1
Servicio de Urgencias, Complejo Hospitalario Universitario de Toledo, Universidad de Castilla-La Mancha, Toledo, España. Electronic address: agustinj@sescam.jccm.es.
2
Servicio de Urgencias, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, España.
3
Servicio de Urgencias, Hospital Regional Universitario de Málaga, Málaga, España.
4
Servicio de Urgencias, Hospital Universitario Virgen de la Victoria, Málaga, España.
5
Servicio de Urgencias, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, España.
6
Servicio de Urgencias, Hospital Verge de la Cinta, Tortosa, Tarragona, España.
7
Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
8
Servicio de Urgencias, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
9
Servicio de Urgencias, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España.

Abstract

OBJECTIVES:

To analyse and compare 30-day mortality prognostic power of several biomarkers (C-reactive protein, procalcitonin, lactate, suPAR and pro-adremomedullin) in elderly patients seen in Emergency Departments (ED) due to infections. Secondly, if these could improve the prognostic accuracy of sepsis criteria (systemic inflammatory response syndrome and quick Sepsis-related Organ Failure Assessment [qSOFA]).

METHODS:

A prospective, observational, multicentre and analytical study. Patients aged 75 years and older who were treated for infection in the ED of 8 participating hospitals were enrolled consecutively. An assessment was made of 25 independent variables (epidemiological, comorbidity, functional, clinical and analytical variables) that could influence short-term mortality (at 30 days).

RESULTS:

The study included 136 patients, 13 (9.5%) of whom died within 30 days of visiting the ED. MR-proADM is the biomarker with the best area under the curve ROC to predict 30-day mortality (0.864; 95% CI 0.775-0.997; P<.001) with a prognostic cut-off>2.07nmol/l, sensitivity of 77% and specificity of 96%. The qSOFA score≥2 had an area under the curve ROC of 0.763 (95% CI 0.623-0.903; P=.002), sensitivity of 76% and specificity of 75%. The mixed model (MR-proADM plus qSOFA≥2) improved the area under the curve ROC to 0.878 (95% CI 0.749-1; P<.001) with the best prognostic performance with sensitivity of 69% and specificity of 97% CONCLUSIONS: MR-proADM showed the best performance for 30-day mortality prognostic power compared to other biomarkers in elderly patients seen in EDs due to infections. qSOFA score achieves better results than systemic inflammatory response syndrome, and the mixed model (qSOFA≥2 plus MR-proADM>2.07nmol/l) increased the predictive power of qSOFA.

KEYWORDS:

Anciano; Biomarcadores; Biomarkers; C-reactive protein; Elderly; Emergency Department; Lactate; Lactato; Mortalidad; Mortality; Pro-adrenomedullin; Proadrenomedulina; Procalcitonin; Procalcitonina; Prognosis; Pronóstico; Proteína C reactiva; Receptor soluble del activador del plasminógeno de tipo urocinasa; Servicio de Urgencias; Soluble urokinase-type plasminogen activator receptor

PMID:
29289378
DOI:
10.1016/j.eimc.2017.11.017

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center