Boston Combined Residency Program, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States of America.
Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States of America; Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America.
Am J Emerg Med. 2021 Dec;50:778-783. doi: 10.1016/j.ajem.2021.09.081. Epub 2021 Oct 6.
To identify the association between readily available laboratory biomarkers and the development of severe sepsis in children presenting to the emergency department (ED) with systemic inflammatory response syndrome (SIRS).
In this retrospective cohort study, ED patient encounters from June 2018 to June 2019 that triggered an automated sepsis alert based on SIRS criteria were analyzed. Encounters were included if the patient had any of the following laboratory tests sent within 6 h of ED arrival: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), lactic acid, and procalcitonin. For each of the biomarkers, a receiver operating characteristic (ROC) curve was created for our primary outcome, severe sepsis within 24 h of ED disposition, and our secondary outcome, severe sepsis with a positive bacterial culture. For each ROC curve, we calculated the area under the curve (AUC) with 95% confidence intervals (95% CI) and created cutoff points to achieve 90% sensitivity and 90% sensitivity for the primary and secondary outcomes.
During the study period, 4349/61,195 (7.1%) encounters triggered an automated sepsis alert. Of those, 1207/4349 (27.8%) had one of the candidate biomarkers sent within 6 h of ED arrival and were included in the study. A total of 100/1207 (8.3%) met criteria for severe sepsis within 24 h of arrival, and 41/100 severe sepsis cases (41%) were deemed culture-positive. Procalcitonin had the highest AUC for identifying severe sepsis [0.62 (95% CI 0.52-0.73)] while ESR and CRP had the highest AUC for culture-positive sepsis [0.68 (95% CI 0.47-0.89) and 0.67 (95% CI 0.53-0.81), respectively]. At 90% sensitivity for detecting severe sepsis, all of the biomarker threshold values fell within that laboratory test's normal range. At 90% specificity for severe sepsis, threshold values were as follows: procalcitonin 2.72 ng/mL, CRP 16.79 mg/dL, ESR 79.5 mm/h and lactic acid 3.6 mmol/L.
Our data indicate that CRP, ESR, lactic acid, and procalcitonin elevations were all specific, but not sensitive, in identifying children in the ED with SIRS who go on to develop severe sepsis.
确定在因全身炎症反应综合征（SIRS）就诊急诊科（ED）的儿童中，哪些易于获得的实验室生物标志物与严重脓毒症的发生相关。
在这项回顾性队列研究中，分析了 2018 年 6 月至 2019 年 6 月期间根据 SIRS 标准触发自动脓毒症警报的 ED 患者就诊情况。如果患者在 ED 就诊后 6 小时内进行了以下任何一项实验室检查，即可纳入研究：C 反应蛋白（CRP）、红细胞沉降率（ESR）、乳酸和降钙素原。对于每个生物标志物，我们都为主要结局（ED 处置后 24 小时内发生严重脓毒症）和次要结局（阳性细菌培养的严重脓毒症）创建了一个接收者操作特征（ROC）曲线。对于每个 ROC 曲线，我们计算了曲线下面积（AUC）及其 95%置信区间（95%CI），并创建了切点，以达到主要和次要结局 90%的敏感性和 90%的特异性。
在研究期间，4349/61195（7.1%）次就诊触发了自动脓毒症警报。在这些患者中，有 1207/4349（27.8%）在 ED 就诊后 6 小时内进行了一项候选生物标志物检查，并被纳入研究。共有 100/1207（8.3%）人在到达后 24 小时内符合严重脓毒症标准，其中 41/100（41%）严重脓毒症病例被认为有细菌培养阳性。降钙素原对识别严重脓毒症的 AUC 最高[0.62（95%CI 0.52-0.73）]，而 ESR 和 CRP 对培养阳性脓毒症的 AUC 最高[0.68（95%CI 0.47-0.89）和 0.67（95%CI 0.53-0.81）]。在检测严重脓毒症的 90%敏感性方面，所有生物标志物的阈值值均在该实验室检查的正常范围内。在 90%特异性的严重脓毒症时，阈值如下：降钙素原 2.72ng/mL，CRP 16.79mg/dL，ESR 79.5mm/h 和乳酸 3.6mmol/L。
我们的数据表明，CRP、ESR、乳酸和降钙素原升高在识别因 SIRS 就诊 ED 的儿童中具有特异性，但不具有敏感性，这些儿童会发展为严重脓毒症。
