Open Access994. Comparison of Lactate, Procalcitonin and a Gene Signature Assay Alone or in Combination to Differentiate Sepsis from Non-infectious Systemic Inflammation in ICU Patients
Author(s) -
Erkan Hassan,
Roy Davis,
Dayle Sampson,
Russell R. Miller
Publication year - 2021
Publication title -
open forum infectious diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.546
H-Index - 35
ISSN - 2328-8957
DOI - 10.1093/ofid/ofab466.1188
Subject(s) - procalcitonin , medicine , sepsis , receiver operating characteristic , intensive care unit , systemic inflammatory response syndrome , confidence interval , area under the curve , gastroenterology
Background Procalcitonin (PCT) and serum lactate (L) are measures of bacterial infection and tissue hypoxia, respectively, but also used to discern sepsis from infection negative systemic inflammation (INSI). However, improved tools are needed to enhance this differentiation. A previously validated gene signature assay (SeptiCyte RAPID) and its correlated score (SeptiScore (SS)) has been reported to effectively differentiate sepsis from INSI. Objective To compare early L, PCT and SS results (alone or in combination) in differentiating sepsis from INSI in adult intensive care unit (ICU) patients (Pt). Methods Data from a previously reported, prospective study (8 sites). Inclusion criteria: (i) ICU admission with ≥ 2 signs of systemic inflammatory response syndrome; (ii) Therapeutic antibiotic administration; (iii) external 3-physician clinical review classifying each Pt as sepsis or INSI with ≥ 2 reviewer agreement; (iv) L, PCT & SS values within 24 hrs of ICU admission; (v) Statistical Analysis; (iv) Area under the receiving operator curve (AUROC), 95% confidence intervals (CI) via generalized linear models for: (i) Each parameter alone (L, PCT, SS); (ii) Combinations (L + PCT, L + SS, PCT + SS, All 3); (iii) AUROC discriminated Sepsis from INSI model: (a) < 0.7 Sub-Optimal; (b) 0.7-0.8 Good; (c) > 0.8 Excellent. Comparisons conducted via paired t-test. Results 222 pts, sepsis=113; INSI=109 Similar demographics between groups (NS). Mean age (SD) = 57.9 (17.1) yrs; 58.1% male). Overall mechanically ventilated 60.8% and hospital mortality 17.1%. AUCROC (95% CI) in Table and Figure; AUCROC of L, PCT or SS alone or in combinationL, PCT, SS Comparison of Sepsis vs INSIConclusion L is sub-optimal in discriminating sepsis from INSI. PCT with or without L was acceptable but not as robust as SS. SS alone or in any combination provided superior and significant discrimination between sepsis and INSI. Incorporation of SS into the clinical assessment process for suspected sepsis pts should be evaluated to determine the impact on early detection and Pt management. Disclosures Erkan Hassan, Pharm.D., FCCM , Immunexpress (Consultant) Roy Davis, M.D> , Immunexpress (Consultant) Immunexpress (Consultant, Shareholder) Dayle Sampson, Ph.D. , Immunexpress (Employee, Shareholder)