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Added value of inflammatory markers to vital signs to predict mortality in patients suspected of severe infection
Added value of inflammatory markers to vital signs to predict mortality in patients suspected of severe infection
- Source :
- American Journal of Emergency Medicine, 38(7), 1389-1395. W.B. Saunders Ltd, Takada, T, Hoogland, J, Yano, T, Fujii, K, Fujiishi, R, Miyashita, J, Takeshima, T, Hayashi, M, Azuma, T & Moons, K G M 2020, ' Added value of inflammatory markers to vital signs to predict mortality in patients suspected of severe infection ', American Journal of Emergency Medicine, vol. 38, no. 7, pp. 1389-1395 . https://doi.org/10.1016/j.ajem.2019.11.030
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- Objective: To evaluate the added value of inflammatory markers to vital signs to predict mortality in patients suspected of severe infection. Methods: This study was conducted at an acute care hospital (471-bed capacity). Consecutive adult patients suspected of severe infection who presented to either ambulatory care or the emergency department from April 2015 to March 2017 were retrospectively evaluated. A prognostic model for predicting 30-day in-hospital mortality based on previously established vital signs (systolic blood pressure, respiratory rate, and mental status) was compared with an extended model that also included four inflammatory markers (C-reactive protein, neutrophil-lymphocyte ratio, mean platelet volume, and red cell distribution width). Measures of interest were model fit, discrimination, and the net percentage of correctly reclassified individuals at the pre-specified threshold of 10% risk. Results: Of the 1015 patients included, 66 (6.5%) died. The extended model including inflammatory markers performed significantly better than the vital sign model (likelihood ratio test: p < 0.001), and the c-index increased from 0.69 (range 0.67–0.70) to 0.76 (range 0.75–0.77) (p = 0.01). All included markers except C-reactive protein showed significant contribution to the model improvement. Among those who died, 9.1% (95% CI −2.8–21.8) were correctly reclassified by the extended model at the 10% threshold. Conclusions: The inflammatory markers except C-reactive protein showed added predictive value to vital signs. Future studies should focus on developing and validating prediction models for use in individualized predictions including both vital signs and the significant markers.
- Subjects :
- Erythrocyte Indices
Male
medicine.medical_specialty
Neutrophils
Organ Dysfunction Scores
Clinical Decision-Making
Vital signs
Blood Pressure
Decision Support Techniques
Sepsis
Leukocyte Count
03 medical and health sciences
0302 clinical medicine
Respiratory Rate
Ambulatory care
Internal medicine
Acute care
medicine
Humans
Hospital Mortality
Lymphocyte Count
Skin Diseases, Infectious
Mean platelet volume
Respiratory Tract Infections
Aged
Retrospective Studies
Aged, 80 and over
Inflammation
business.industry
030208 emergency & critical care medicine
Red blood cell distribution width
General Medicine
Emergency department
Middle Aged
Prognosis
medicine.disease
C-Reactive Protein
Blood pressure
Urinary Tract Infections
Emergency Medicine
Intraabdominal Infections
Female
business
Mean Platelet Volume
Subjects
Details
- ISSN :
- 07356757
- Volume :
- 38
- Database :
- OpenAIRE
- Journal :
- The American Journal of Emergency Medicine
- Accession number :
- edsair.doi.dedup.....09e472322635ffa8cee0bac908c59087
- Full Text :
- https://doi.org/10.1016/j.ajem.2019.11.030