BACKGROUND Few validated biomarker or clinical score combinations exist which can discriminate between cases of infection and other non-infectious conditions following activation of an in-hospital sepsis code, as well as provide an accurate severity assessment of the corresponding host response. This study aimed to identify suitable blood biomarker (MR-proADM, PCT, CRP and lactate) or clinical score (SOFA and APACHE II) combinations to address this unmet clinical need. METHODS A prospective, observational study of patients activating the Vall d'Hebron University Hospital sepsis code (ISC) within the emergency department (ED), hospital wards and intensive care unit (ICU). Area under the receiver operating characteristic (AUROC) curves, logistic and Cox regression analysis were used to assess performance. RESULTS 148 patients fulfilled the Vall d'Hebron ISC criteria, of which 130 (87.8%) were retrospectively found to have a confirmed diagnosis of infection. Both PCT and MR-proADM had a moderate-to-high performance in discriminating between infected and non-infected patients following ISC activation, although the optimal PCT cut-off varied significantly across departments. Similarly, MR-proADM and SOFA performed well in predicting 28- and 90-day mortality within the total infected patient population, as well as within patients presenting with a community-acquired infection or following a medical emergency or prior surgical procedure. Importantly, MR-proADM also showed a high association with the requirement for ICU admission after ED presentation [OR (95% CI) 8.18 (1.75-28.33)] or during treatment on the ward [OR (95% CI) 3.64 (1.43-9.29)], although the predictive performance of all biomarkers and clinical scores diminished between both settings. CONCLUSIONS Results suggest that the individual use of PCT and MR-proADM might help to accurately identify patients with infection and assess the overall severity of the host response, respectively. In addition, the use of MR-proADM could accurately identify patients requiring admission onto the ICU, irrespective of whether patients presented to the ED or were undergoing treatment on the ward. Initial measurement of both biomarkers might therefore facilitate early treatment strategies following activation of an in-hospital sepsis code.

中文翻译：

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生物标志物和临床评分有助于在激活医院败血症代码后识别疾病严重程度和重症监护需求。

背景技术很少有经过验证的生物标志物或临床评分组合可以在激活医院败血症代码后区分感染病例和其他非感染性疾病，以及提供相应宿主反应的准确严重性评估。这项研究旨在确定合适的血液生物标志物（MR-proADM，PCT，CRP和乳酸盐）或临床评分（SOFA和APACHE II）组合，以解决这一未满足的临床需求。方法对在急诊科（ED），医院病房和重症监护病房（ICU）内激活Vall d'Hebron大学医院败血症代码（ISC）的患者进行前瞻性观察研究。接收器工作特性（AUROC）曲线下方的面积，逻辑分析和Cox回归分析用于评估性能。结果148例患者符合Vall d'Hebron ISC标准，其中130例（87.8％）回顾性发现已确诊感染。PCT和MR-proADM在ISC激活后区分感染患者和未感染患者方面均具有中等至较高的表现，尽管最佳PCT截止值在各个部门之间差异很大。同样，MR-proADM和SOFA在预测总感染患者群体中以及在出现社区获得性感染或在医疗紧急情况或先前的手术程序后的28天和90天死亡率方面表现良好。重要的是，MR-proADM还显示出ED出现后[OR（95％CI）8.18（1.75-28.33）]或病房治疗期间[OR（95％CI）3.64（1.43- 9.29）]，尽管两种设置之间所有生物标志物和临床评分的预测性能均下降。结论结果表明，单独使用PCT和MR-proADM可能分别有助于准确识别感染患者并评估宿主反应的总体严重程度。此外，使用MR-proADM可以准确识别需要入院的患者，而不论患者是急诊还是正在病房就诊。因此，对两种生物标志物的初始测量可能会促进院内败血症代码激活后的早期治疗策略。结论结果表明，单独使用PCT和MR-proADM可能分别有助于准确识别感染患者并评估宿主反应的总体严重程度。另外，使用MR-proADM可以准确地识别需要入院的患者，而不管患者是去急诊室还是在病房接受治疗。因此，对两种生物标志物的初始测量可能会促进院内败血症代码激活后的早期治疗策略。结论结果表明，单独使用PCT和MR-proADM可能分别有助于准确识别感染患者并评估宿主反应的总体严重程度。此外，使用MR-proADM可以准确识别需要入院的患者，而不论患者是急诊还是正在病房就诊。因此，对两种生物标志物的初始测量可能会促进院内败血症代码激活后的早期治疗策略。