Discriminative Value of Sepsis Biomarkers in the Febrile ED Patient (original) (raw)

Abstract

ABSTRACT Background: Rapid identification of sepsis and early aggressive management are vital to improving outcomes. Circulating biomarkers provide a mechanism to rapidly and accurately identify sepsis. We evaluated the performance of procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL6) in patients presenting to an ED with suspected sepsis. Methods: Febrile (T≥38.0C) adults presenting to the Duke or Durham VAMC ED were screened. Upon enrollment, we collected standardized demographic and clinical data including microbiological specimens as clinically indicated. PCT, CRP, IL6 and WBC count were measured at enrollment. Patients were categorized as having definite, possible or no infection. Biomarker levels were correlated to the likelihood of infection, sepsis severity and the presence of septicemia. Results: Of 336 enrolled subjects, 203 (60%) had definite infection, 43 (13%) had possible infection and 90 (27%) had non-infectious etiologies. Of those with definite or possible infection, 167 (68%) presented with sepsis, 54 (22%) with severe sepsis and 25 (10%) with septic shock. Overall, 21% of subjects were septicemic. PCT, IL6 and CRP levels were significantly higher in septicemic subjects (PCT 19.6 vs 2.2 ng/mL; IL6 783 vs. 307 pg/mL; CRP 162 vs. 91 mg/dL, p<0.001 for all). PCT, IL6 and CRP also discriminated definite from possible or no infection. Area under the ROC curves revealed that PCT best predicted septicemia (0.78 vs IL6 0.69 and CRP 0.67) but CRP was better for identifying definite or possible infection (0.74 vs PCT 0.70 and IL6 0.68). Conclusion: PCT, CRP and IL6 are moderately effective in identifying sepsis in febrile ED patients. PCT in particular can help discriminate febrile ED patients at risk of septicemia.

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