Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3508 GA, Utrecht, the Netherlands.
Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands.
J Appl Lab Med. 2022 Sep 1;7(5):1088-1097. doi: 10.1093/jalm/jfac031.
Point-of-care testing (POCT) has shown promising results in the primary care setting to improve antibiotic therapy in respiratory tract infections and it might also aid general practitioners (GPs) to decide if patients should be referred to a hospital in cases of suspected sepsis. We aimed to assess whether biomarkers with possible POCT use can improve the recognition of sepsis in adults in the primary care setting.
We prospectively included adult patients with suspected severe infections during out-of-hours home visits. Relevant clinical signs and symptoms were recorded, as well as the biomarkers C-reactive protein, lactate, procalcitonin, high-sensitive troponin I, N-terminal pro b-type natriuretic peptide, creatinine, urea, and pancreatic stone protein. We used a POCT device for lactate only, and the remaining biomarkers were measured in a laboratory from stored blood samples. The primary outcome was sepsis within 72 h of inclusion. The potential of biomarkers to either rule in or rule out sepsis was tested for individual biomarkers combined with a model consisting of signs and symptoms. Net reclassification indices were also calculated.
In total, 336 patients, with a median age of 80 years, were included. One hundred forty-one patients (42%) were diagnosed with sepsis. The C statistic for the model with clinical symptoms and signs was 0.84 (95% CI 0.79-0.88). Both lactate and procalcitonin increased the C statistic to 0.85, but none of the biomarkers significantly changed the net reclassification index.
We do not advocate the routine use of POCT in general practice for any of the tested biomarkers of suspected sepsis.
即时检验（POCT）在初级保健环境中已显示出改善呼吸道感染抗生素治疗的良好效果，它也可能有助于全科医生（GP）在疑似脓毒症的情况下决定是否将患者转至医院。我们旨在评估是否可以使用具有 POCT 可能性的生物标志物来改善初级保健环境中成人对脓毒症的识别。
我们前瞻性地纳入了家庭就诊时疑似严重感染的成年患者。记录了相关的临床体征和症状，以及生物标志物 C 反应蛋白、乳酸、降钙素原、高敏肌钙蛋白 I、N 末端 pro B 型利钠肽、肌酐、尿素和胰腺结石蛋白。我们仅使用 POCT 设备检测乳酸，其余生物标志物则使用存储的血液样本在实验室进行测量。主要结局是纳入后 72 小时内的脓毒症。我们测试了单个生物标志物与包含体征和症状的模型相结合对诊断脓毒症的可能性。还计算了净重新分类指数。
共纳入了 336 名中位年龄为 80 岁的患者。其中 141 名患者（42%）被诊断为脓毒症。包含临床症状和体征的模型的 C 统计量为 0.84（95% CI 0.79-0.88）。乳酸和降钙素原均提高了 C 统计量至 0.85，但没有一种生物标志物显著改变净重新分类指数。
我们不主张在一般实践中常规使用 POCT 检测疑似脓毒症的任何测试生物标志物。
