Gyula Molnár1, V. Anna Gyarmathy1,2,3, Johanna Takács1, Szilárd Sándor1, Bálint Kiss1, Péter László Kanizsai1
1 Semmelweis University, Faculty of Medicine, Budapest, Hungary
2 EpiConsult LLC, Dover, DE, USA
3 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Introduction: There is controversy surrounding the use of different sepsis scores, vital parameters, and laboratory results to diagnose sepsis.
Aims: We investigated whether selected physiologic and metabolic parameters can be reliably used in the emergency department to differentiate sepsis from other disease states that mimic it, such as dehydration and stroke.
Methods: We performed a retrospective chart review of patients aged 18+ in the Department of Emergency Medicine, Clinical Centre, Semmelweis University, Hungary. The primary outcome was sepsis. Independent variables were gender, age, body temperature, mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), pH, lactate levels, and bicarbonate levels. Loess regression was used to identify inflexion points, and multivariate logistic regression to assess associations and the area under the receiver operating characteristic (ROC) curve.
Results: Of 664 patients 205 had sepsis, 244 dehydration, and 215 stroke. U, V, W or reverse U-shaped inflexions were identified for age (risk:56-83 years), body temperature (risk:<35.6, >37.3 °C), bicarbonate (risk:<22.3 mM/l), HR (risk:<53, >91 bpm), lactate (risk:<1, >2.5 mM/l), and pH (risk:<7.34, >7.45). In the final multivariate analysis, RR and high-risk age, bicarbonate, HR, pH, and body temperature were positively associated; and MAP was inversely associated with sepsis risk – gender and lactate did not stay in the model. The area under the ROC curve was 0.9021.
Conclusions: We can conclude that in addition to some SIRS and qSOFA parameters that are easy to measure at triage level, other easily measurable variables, such as pH, bicarbonate levels, and age might be useful in the diagnosis of sepsis in the ER.
Doctoral School: Basic and Translational Medicine
Program: Physiology and Pathophysiology of the Regulation of Fluids and Electrolyte Homeostasis
Supervisor: Peter Kanizsai M.D., Ph.D., DEAA
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