Combining Blood-Based Biomarkers to Predict Mortality of Sepsis at Arrival at the Emergency Department

Abstract

Background Our aim was to determine a useful combination of blood biomarkers that can predict 28-day mortality of sepsis upon arrival at the Emergency Department (ED). Material/Methods Based on Sepsis-3.0, 90 sepsis patients were enrolled and divided into survivor and nonsurvivor groups with day 28 as the study end point. After comparing the demographic data and clinical characteristics of patients, we evaluated the predictive validity of a combination of markers including interleukin-6 (IL-6), procalcitonin (PCT), and lactate at arrival at the ED. Independent risk factors were found by using univariate and multivariate logistic regression analyses, and the prognostic value of markers was determined by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. Results There were 67 (74.4%) survivors and 23 (25.6%) nonsurvivors. The levels of IL-6 (survivors vs nonsurvivors: median 205.30 vs 3499.00 pg/mL, P =0.012) and lactate (survivors vs nonsurvivors: median 2.37 vs 5.77 mmol/L, P =0.003) were significantly lower in survivor group compared with the nonsurvivor group. Markers including IL-6, PCT, lactate, and neutrophil-to-white blood cell ratio (NWR) were independent risk factors in predicting 28-day mortality due to sepsis. The combination of these 4 markers provided the best predictive performance for 28-day mortality of patients with sepsis, on arrival at the ED (AUC of 0.823, 95% confidence interval [CI] 0.723–0.924), and its accuracy, specificity, and sensitivity were 74.4% (95% CI 64.0–82.8%), 91% (95% CI 80.9–96.3%), and 65% (95% CI 42.8–82.8%), respectively. Conclusions The combination of IL-6, PCT, lactate, and NWR measurements is a potential predictor of 28-day mortality for patients with sepsis, at arrival at the ED. Further research is needed to confirm our findings.

Comparing the Prognostic Value of Lactate to the Neutrophil to Lymphocyte Ratio Among Sepsis Patients: a Prospective Cohort Study

“…Another study by Xie et al showed no association between NLR and 28-day mortality in patients diagnosed with sepsis (42). In a study done by Sari et al, the AUC of NLR at the rst day of ICU admission in septic shock patients was: 0.515 with a p-value of 0.73 (43).…”

Hierarchical Capability in Distinguishing Severities of Sepsis via Serum Lactate: A Network Meta-Analysis

“…Also, most of them provided data on the association between nonsepsis, sepsis, severe sepsis and septic shock and different blood lactate values. Meanwhile, there were 82 studies that demonstrated the relationship between blood lactate and sepsis induced mortality [9,11,15,19,31,34,36,[38][39][40][42][43][44][45][46][47][48][49][50][51]53,55,58,59,62,63,65,[67][68][69][70][71][72][74][75][76]78,81,83,85,[87][88][89]91,93,95,. Additionally, there were 46 articles reported the diagnostic accuracy of blood lactate levels in determining sepsis and associated clinical prognosis [11,15,31,33,34,38,43-45,50,53,56,59,64-67,69...…”

Basal procalcitonin, C-reactive protein, interleukin-6, and presepsin for prediction of mortality in critically ill septic patients: a systematic review and meta-analysis

“…Sixty studies including 15,681 critically ill septic patients evaluated the role of at least one of our selected biomarkers for mortality prediction [ 23 – 62 ]. We contacted 11 study teams for additional information, and we received replies from three [ 27 , 33 , 56 ]. Fifty-five (91.7%) studies were published in the last 10 years (2012–2023), and 30 (50.0%) were published in the previous 3 years.…”