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Sisto UG, Di Bella S, Porta E, Franzoi G, Cominotto F, Guzzardi E, Artusi N, Giudice CA, Dal Bo E, Collot N, Sirianni F, Russo S, Sanson G. Predicting sepsis at emergency department triage: Implementing clinical and laboratory markers within the first nursing assessment to enhance diagnostic accuracy. J Nurs Scholarsh 2024. [PMID: 38886920 DOI: 10.1111/jnu.13002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/27/2024] [Accepted: 06/06/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Early identification of sepsis in the emergency department (ED) triage is both valuable and challenging. Numerous studies have endeavored to pinpoint clinical and biochemical criteria to assist clinicians in the prompt diagnosis of sepsis, but few studies have assessed the efficacy of these criteria in the ED triage setting. The aim of the study was to explore the accuracy of clinical and laboratory markers evaluated at the triage level in identifying patients with sepsis. METHODS A prospective study was conducted in a large academic urban hospital, implementing a triage protocol aimed at early identification of septic patients based on clinical and laboratory markers. A multidisciplinary panel of experts reviewed cases to ensure accurate identification of septic patients. Variables analyzed included: Charlson comorbidity index, mean arterial pressure (MAP), partial pressure of carbon dioxide (PetCO2), white cell count, eosinophil count, C-reactive protein to albumin ratio, procalcitonin, and lactate. RESULTS A total of 235 patients were included. Multivariable analysis identified procalcitonin ≥1 ng/mL (OR 5.2; p < 0.001); CRP-to-albumin ratio ≥32 (OR 6.6; p < 0.001); PetCO2 ≤ 28 mmHg (OR 2.7; p = 0.031), and MAP <85 mmHg (OR 7.5; p < 0.001) as independent predictors for sepsis. MAP ≥85 mmHg, CRP/albumin ratio <32, and procalcitonin <1 ng/mL demonstrated negative predictive values for sepsis of 90%, 89%, and 88%, respectively. CONCLUSIONS Our study underscores the significance of procalcitonin and mean arterial pressure, while introducing CRP/albumin ratio and PetCO2 as important variables to consider in the very initial assessment of patients with suspected sepsis in the ED. CLINICAL RELEVANCE Early identification of sepsis since the emergency department (ED) triage is challenging Implementing the ED triage protocol with simple clinical and laboratory markers allows to recognize patients with sepsis with a very good discriminatory power (AUC 0.88).
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Affiliation(s)
- Ugo Giulio Sisto
- Emergency Medicine Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
- Infectious Diseases Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Elisa Porta
- Clinical Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Giorgia Franzoi
- Clinical Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Franco Cominotto
- Emergency Medicine Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Elena Guzzardi
- Emergency Medicine Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Nicola Artusi
- Emergency Medicine Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Caterina Anna Giudice
- Emergency Medicine Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Eugenia Dal Bo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Nicholas Collot
- Clinical Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Francesca Sirianni
- Medicine of Services Department, Clinical Analysis Laboratory, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Savino Russo
- Emergency Medicine Department, Azienda Sanitaria Friuli Centrale, Palmanova, Italy
| | - Gianfranco Sanson
- Clinical Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
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Eosinopenie als Biomarker des Schweregrads einer COVID-19-Infektion. KOMPASS PNEUMOLOGIE 2022. [PMCID: PMC8678220 DOI: 10.1159/000520808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Studies on the role of eosinophils in coronavirus disease 2019 (COVID-19) are scarce, though available findings suggest a possible association with disease severity. Our study analyzes the relationship between eosinophils and COVID-19, with a focus on disease severity and patients with underlying chronic respiratory diseases. Methods We performed a retrospective analysis of 3018 subjects attended at two public hospitals in Madrid (Spain) with PCR-confirmed SARS-CoV-2 infection from January 31 to April 17, 2020. Patients with eosinophil counts less than 0.02×109/L were considered to have eosinopenia. Individuals with chronic respiratory diseases (n = 384) were classified according to their particular underlying condition, i.e., asthma, chronic pulmonary obstructive disease, or obstructive sleep apnea. Results Of the 3018 patients enrolled, 479 were excluded because of lack of information at the time of admission. Of 2539 subjects assessed, 1396 patients presented an eosinophil count performed on admission, revealing eosinopenia in 376 cases (26.93%). Eosinopenia on admission was associated with a higher risk of intensive care unit (ICU) or respiratory intensive care unit (RICU) admission (OR:2.21; 95%CI:1.42–3.45; p <0.001) but no increased risk of mortality (p >0.05). Conclusion Eosinopenia on admission conferred a higher risk of severe disease (requiring ICU/RICU care), but was not associated with increased mortality. In patients with chronic respiratory diseases who develop COVID-19, age seems to be the main risk factor for progression to severe disease or death.
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Tordjman M, Mekki A, Mali RD, Saab I, Chassagnon G, Guillo E, Burns R, Eshagh D, Beaune S, Madelin G, Bessis S, Feydy A, Mihoubi F, Doumenc B, Mouthon L, Carlier RY, Drapé JL, Revel MP. Pre-test probability for SARS-Cov-2-related infection score: The PARIS score. PLoS One 2020; 15:e0243342. [PMID: 33332360 PMCID: PMC7745977 DOI: 10.1371/journal.pone.0243342] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/19/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION In numerous countries, large population testing is impossible due to the limited availability of RT-PCR kits and CT-scans. This study aimed to determine a pre-test probability score for SARS-CoV-2 infection. METHODS This multicenter retrospective study (4 University Hospitals) included patients with clinical suspicion of SARS-CoV-2 infection. Demographic characteristics, clinical symptoms, and results of blood tests (complete white blood cell count, serum electrolytes and CRP) were collected. A pre-test probability score was derived from univariate analyses of clinical and biological variables between patients and controls, followed by multivariate binary logistic analysis to determine the independent variables associated with SARS-CoV-2 infection. RESULTS 605 patients were included between March 10th and April 30th, 2020 (200 patients for the training cohort, 405 consecutive patients for the validation cohort). In the multivariate analysis, lymphocyte (<1.3 G/L), eosinophil (<0.06 G/L), basophil (<0.04 G/L) and neutrophil counts (<5 G/L) were associated with high probability of SARS-CoV-2 infection but no clinical variable was statistically significant. The score had a good performance in the validation cohort (AUC = 0.918 (CI: [0.891-0.946]; STD = 0.014) with a Positive Predictive Value of high-probability score of 93% (95%CI: [0.89-0.96]). Furthermore, a low-probability score excluded SARS-CoV-2 infection with a Negative Predictive Value of 98% (95%CI: [0.93-0.99]). The performance of the score was stable even during the last period of the study (15-30th April) with more controls than infected patients. CONCLUSIONS The PARIS score has a good performance to categorize the pre-test probability of SARS-CoV-2 infection based on complete white blood cell count. It could help clinicians adapt testing and for rapid triage of patients before test results.
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Affiliation(s)
| | - Ahmed Mekki
- Department of Radiology, Ambroise Paré Hospital, APHP, Boulogne, France
| | - Rahul D. Mali
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, United States of America
| | - Ines Saab
- Department of Radiology, Cochin Hospital, APHP, Paris, France
| | - Guillaume Chassagnon
- Department of Radiology, Cochin Hospital, APHP, Paris, France
- Université de Paris, Paris, France
| | - Enora Guillo
- Department of Radiology, Cochin Hospital, APHP, Paris, France
| | - Robert Burns
- Department of Radiology, Cochin Hospital, APHP, Paris, France
| | - Deborah Eshagh
- Department of Internal Medicine, Saint Antoine Hospital, APHP, Paris, France
| | - Sebastien Beaune
- Emergency Department, Ambroise Paré Hospital, APHP, Boulogne, France
| | - Guillaume Madelin
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, United States of America
| | - Simon Bessis
- Department of Infectious diseases, Raymond Poincaré Hospital, APHP, Garches, France
| | - Antoine Feydy
- Department of Radiology, Cochin Hospital, APHP, Paris, France
- Université de Paris, Paris, France
| | - Fadila Mihoubi
- Department of Radiology, Cochin Hospital, APHP, Paris, France
| | - Benoit Doumenc
- Emergency Department, Cochin Hospital, APHP, Paris, France
| | - Luc Mouthon
- Department of Internal Medicine, Cochin Hospital, APHP, Paris, France
| | - Robert-Yves Carlier
- Department of Radiology, Ambroise Paré Hospital, APHP, Boulogne, France
- Department of Radiology, Raymond Poincaré Hospital, APHP, Garches, France
- DMU Smart Imaging, APHP, Paris, France
| | - Jean-Luc Drapé
- Department of Radiology, Cochin Hospital, APHP, Paris, France
- Université de Paris, Paris, France
| | - Marie-Pierre Revel
- Department of Radiology, Cochin Hospital, APHP, Paris, France
- Université de Paris, Paris, France
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Ndieugnou Djangang N, Peluso L, Talamonti M, Izzi A, Gevenois PA, Garufi A, Goffard JC, Henrard S, Severgnini P, Vincent JL, Creteur J, Taccone FS. Eosinopenia in COVID-19 Patients: A Retrospective Analysis. Microorganisms 2020; 8:microorganisms8121929. [PMID: 33291791 PMCID: PMC7762070 DOI: 10.3390/microorganisms8121929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/15/2020] [Accepted: 12/03/2020] [Indexed: 12/24/2022] Open
Abstract
Objectives: The aim of this study was to assess the diagnostic role of eosinophils count in COVID-19 patients. Methods: Retrospective analysis of patients admitted to our hospital with suspicion of COVID-19. Demographic, clinical and laboratory data were collected on admission. Eosinopenia was defined as eosinophils < 100 cells/mm3. The outcomes of this study were the association between eosinophils count on admission and positive real-time reverse transcription polymerase chain reaction (rRT-PCR) test and with suggestive chest computerized tomography (CT) of COVID-19 pneumonia. Results: A total of 174 patients was studied. Of those, 54% had positive rRT-PCR for SARS-CoV-2. A chest CT-scan was performed in 145 patients; 71% showed suggestive findings of COVID-19. Eosinophils on admission had a high predictive accuracy for positive rRT-PCR and suggestive chest CT-scan (area under the receiver operating characteristic-ROC curve, 0.84 (95% CIs 0.78-0.90) and 0.84 (95% CIs 0.77-0.91), respectively). Eosinopenia and high LDH were independent predictors of positive rRT-PCR, whereas eosinopenia, high body mass index and hypertension were predictors for suggestive CT-scan findings. Conclusions: Eosinopenia on admission could predict positive rRT-PCR test or suggestive chest CT-scan for COVID-19. This laboratory finding could help to identify patients at high-risk of COVID-19 in the setting where gold standard diagnostic methods are not available.
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Affiliation(s)
- Narcisse Ndieugnou Djangang
- Department of Intensive Care, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (N.N.D.); (M.T.); (A.I.); (A.G.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Lorenzo Peluso
- Department of Intensive Care, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (N.N.D.); (M.T.); (A.I.); (A.G.); (J.-L.V.); (J.C.); (F.S.T.)
- Correspondence: ; Tel.: +32-25553416
| | - Marta Talamonti
- Department of Intensive Care, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (N.N.D.); (M.T.); (A.I.); (A.G.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Antonio Izzi
- Department of Intensive Care, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (N.N.D.); (M.T.); (A.I.); (A.G.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Pierre Alain Gevenois
- Department of Radiology, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium;
| | - Alessandra Garufi
- Department of Intensive Care, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (N.N.D.); (M.T.); (A.I.); (A.G.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Jean-Christophe Goffard
- Department of Internal Medicine, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (J.-C.G.); (S.H.)
| | - Sophie Henrard
- Department of Internal Medicine, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (J.-C.G.); (S.H.)
| | - Paolo Severgnini
- Dipartimento Biotecnologie e Scienze della Vita, Università degli studi dell’ Insubria, U.O. Anestesia e Rianimazione Cardiologica ASST Sette Laghi, 21100 Varese, Italy;
| | - Jean-Louis Vincent
- Department of Intensive Care, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (N.N.D.); (M.T.); (A.I.); (A.G.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Jacques Creteur
- Department of Intensive Care, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (N.N.D.); (M.T.); (A.I.); (A.G.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Fabio Silvio Taccone
- Department of Intensive Care, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (N.N.D.); (M.T.); (A.I.); (A.G.); (J.-L.V.); (J.C.); (F.S.T.)
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Eosinopenia as predictor of infection in patients admitted to an internal medicine ward: a cross-sectional study. Porto Biomed J 2020; 5:e084. [PMID: 33204891 PMCID: PMC7665260 DOI: 10.1097/j.pbj.0000000000000084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/15/2020] [Indexed: 01/21/2023] Open
Abstract
Supplemental Digital Content is available in the text Background: The identification of infection in an internal medicine ward is crucial but not always straightforward. Eosinopenia has been proposed as a marker of infection, but specific cutoffs for prediction are not established yet. We aim to assess whether there is difference in eosinophil count between infected and noninfected patients and, if so, the best cutoffs to differentiate them. Methods: Cross-sectional, observational study with analysis of all patients admitted to an Internal Medicine Department during 2 consecutive months. Clinical, laboratory and imaging data were analyzed. Infection at hospital admission was defined in the presence of either a microbiological isolation or suggestive clinical, laboratory, and/or imaging findings. Use of antibiotics in the 8 days before hospital admission, presence of immunosuppression, hematologic neoplasms, parasite, or fungal infections were exclusion criteria. In case of multiple hospital admissions, only the first admission was considered. Sensitivity and specificity values for eosinophils, leukocytes, neutrophils, and C-reactive protein were determined by receiver operating characteristic curve. Statistical analysis was performed with IBM SPSS Statistics® v25 and MedCalc Statistical Software® v19.2.3. Results: A total of 323 hospitalization episodes were evaluated, each corresponding to a different patient. One hundred fifteen patients were excluded. A total of 208 patients were included, 62.0% (n = 129) of them infected at admission. Ten patients had multiple infections. Infected patients had fewer eosinophils than uninfected patients (15.8 ± 42 vs 71.1 ± 159 cell/mm3; P < .001). An eosinophil count at admission ≤69 cell/mm3 had a sensitivity of 89.1% and specificity of 54.4% (area under the curve 0.752; 95% confidence interval 0.682–0.822) for the presence of infection. Eosinophil count of >77 cells/mm3 had a negative likelihood ratio of 0.16. Conclusions: Eosinophil count was significantly lower in infected than in uninfected patients. The cutoff 69 cells/mm3 was the most accurate in predicting infection. Eosinophil count >77 cells/mm3 was a good predictor of absence of infection.
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Lavoignet CE, Le Borgne P, Chabrier S, Bidoire J, Slimani H, Chevrolet-Lavoignet J, Lefebvre F, Jebri R, Sengler L, Bilbault P. White blood cell count and eosinopenia as valuable tools for the diagnosis of bacterial infections in the ED. Eur J Clin Microbiol Infect Dis 2019; 38:1523-1532. [PMID: 31119578 DOI: 10.1007/s10096-019-03583-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/06/2019] [Indexed: 12/29/2022]
Abstract
Identifying an infection may be difficult in the ED. Neutrophilic leukocytosis is often used in the diagnosis of infection despite its lack of specificity in situations of stress. Our objective was to study the value of each parameter of the WBC count, in particular eosinopenia, to diagnose bacterial infections in the ED. We conducted a retrospective and observational study over a period of 6 months. All patients with one of the following diagnoses were eligible: pneumonia (9.9%), pyelonephritis (26.2%), prostatitis (8.4%), appendicitis (26.2%), cholecystitis (8.4%), and diverticular sigmoiditis (5%). A total of 466 infected patients were included for statistical analysis, and a control group of 466 uninfected patients was randomly selected in the same period of time. All leukocyte count parameters were significantly modified (p < 0.001) in the infected group compared with the control group. Neutrophils and total leukocytes remain the two most suitable parameters for the diagnosis of infections in the ED. Eosinopenia represented the most efficient parameter of the WBC count for the diagnosis of urinary and biliary tract infections. Deep eosinopenia presented a specificity of 94% for the diagnosis of infection. Any modification of the WBC count associated with an elevation of CRP (> 40 mg/L) or fever (> 38.5 °C) showed a high specificity for the diagnosis of infection. A careful analysis of the WBC count remains a valuable tool for the diagnosis of infection in the ED.
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Affiliation(s)
- Charles-Eric Lavoignet
- Emergency Department, Nord Franche-Comté Hospital, Trevenans, France
- Emergency Department, Hautepierre Hospital, University Hospital of Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France
- CREMS: Clinical Research in Emergency Medicine and Sepsis Network, Wolfisheim, France
| | - Pierrick Le Borgne
- Emergency Department, Hautepierre Hospital, University Hospital of Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France.
- CREMS: Clinical Research in Emergency Medicine and Sepsis Network, Wolfisheim, France.
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, Strasbourg, France.
| | - Sylvie Chabrier
- Emergency Department, Hautepierre Hospital, University Hospital of Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France
| | - Joffrey Bidoire
- Emergency Department, Nord Franche-Comté Hospital, Trevenans, France
| | - Hakim Slimani
- Emergency Department, Nord Franche-Comté Hospital, Trevenans, France
| | | | - François Lefebvre
- Department of Public Health, University Hospital of Strasbourg, Strasbourg, France
| | - Rania Jebri
- Emergency Department, Erasme Hospital, Anderlecht, Belgium
| | - Luc Sengler
- Emergency Department, Nord Franche-Comté Hospital, Trevenans, France
| | - Pascal Bilbault
- Emergency Department, Hautepierre Hospital, University Hospital of Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France
- CREMS: Clinical Research in Emergency Medicine and Sepsis Network, Wolfisheim, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, Strasbourg, France
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