Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
BMC Emerg Med. 2023 Feb 11;23(1):16. doi: 10.1186/s12873-023-00785-y.
Deciding whether to transfer patients with sepsis from the emergency department (ED) to intensive care units (ICUs) is challenging. We hypothesised that the new biomarker plasma calprotectin (p-calprotectin) could be used to aid the selection of patients for intensive care transfer, since it has been shown to be a promising tool for the determination of sepsis severity in critical care.
This prospective study was performed on consecutive sepsis alert patients in the ED of Karolinska University Hospital Huddinge. The sepsis alert mandates clinical assessment and decisions regarding treatment, disposition, and level of care by physicians from the ED, the Department of Infectious Diseases, and the ICU. Blood sample analysis for C-reactive protein, procalcitonin, neutrophils, and lymphocytes was routinely performed. P-calprotectin was analysed from frozen plasma samples, using a specific turbidimetric assay.
Three-hundred fifty-one patients who triggered the sepsis alert were available for the study. Among 319 patients who were considered to have an infection, 66 patients (26%) were immediately transferred to the ICU or high-dependency unit (HDU), and 253 patients (74%) were transferred to ordinary wards. Median p-calprotectin was 2.2 mg/L (IQR 1.2-3.9 mg/L) for all patients with infection, it was 3.3 (IQR 1.6-5.2) for those transferred to ICU/HDU and 2.1 (IQR 1.1-3.5) for those transferred to ward units (p = 0.0001). Receiver operating characteristic curve analysis for transfer to the ICU/HDU showed superiority for p-calprotectin compared with procalcitonin and neutrophil-lymphocyte ratio, regarding both all sepsis alert cases and the patients with infection (p < 0.001 for all comparisons). The best p-calprotectin cut-off, 4.0 mg/L, showed a sensitivity of 42.5% and specificity of 83% for transfer to the ICU/HDU among patients with infection.
In sepsis alert patients, p-calprotectin was significantly elevated in patients who were subject to immediate ICU/HDU transfer after assessment by a multidisciplinary team. P-calprotectin was superior to traditional biomarkers in predicting the need for transfer to the ICU/HDU.
决定是否将败血症患者从急诊部（ED）转至重症监护病房（ICU）是一项挑战。我们假设新的生物标志物血浆钙卫蛋白（p-calprotectin）可用于辅助选择需要转入 ICU 的患者，因为它已被证明是一种有前途的工具，可用于确定重症监护中的败血症严重程度。
这项前瞻性研究在 Karolinska University Hospital Huddinge 的 ED 连续进行了败血症警报患者。败血症警报需要 ED、传染病科和 ICU 的医生进行临床评估并做出有关治疗、处置和护理级别的决策。常规进行 C-反应蛋白、降钙素原、中性粒细胞和淋巴细胞的血液样本分析。使用特定的比浊测定法分析冷冻血浆样本中的 p-calprotectin。
有 351 名触发败血症警报的患者可用于研究。在 319 名被认为患有感染的患者中，有 66 名患者（26%）立即转至 ICU 或高依赖病房（HDU），253 名患者（74%）转至普通病房。所有感染患者的中位 p-calprotectin 为 2.2mg/L（IQR 1.2-3.9mg/L），转至 ICU/HDU 的患者为 3.3mg/L（IQR 1.6-5.2），转至病房的患者为 2.1mg/L（IQR 1.1-3.5）（p=0.0001）。针对 ICU/HDU 转科的受试者工作特征曲线分析显示，p-calprotectin 优于降钙素原和中性粒细胞-淋巴细胞比值，无论是所有败血症警报病例还是感染患者（所有比较的 p<0.001）。最佳 p-calprotectin 截断值为 4.0mg/L，感染患者中 ICU/HDU 转科的敏感性为 42.5%，特异性为 83%。
在败血症警报患者中，经过多学科团队评估后，立即转至 ICU/HDU 的患者的 p-calprotectin 明显升高。p-calprotectin 在预测转入 ICU/HDU 的需求方面优于传统生物标志物。
