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Sepsis - an ED perspective. Sepsis Alert & Biomarkers.

Rosenqvist, Mari LU (2021) In Lund University, Faculty of Medicine Doctoral Dissertation Series
Abstract
Background: Sepsis, the life-threatening organ dysfunction due to dysregulated host response to an infection, is a medical emergency. Early diagnosis and treatment are important factors to prevent mortality and morbidity. However, sepsis can be diffuse and difficult to interpret. Therefore, it is important to define models for early identification applicable in the Emergency Department (ED), in order to meet the therapeutic goals of the Surviving Sepsis Campaign (SSC).Aim: To improve initial sepsis care at the ED by identifying biomarkers for risk stratification and by a region-wide implementation of the novel triage model Sepsis Alert.
Methods: In the first study we retrospectively evaluated the implementation of the Sepsis Alert at... (More)
Background: Sepsis, the life-threatening organ dysfunction due to dysregulated host response to an infection, is a medical emergency. Early diagnosis and treatment are important factors to prevent mortality and morbidity. However, sepsis can be diffuse and difficult to interpret. Therefore, it is important to define models for early identification applicable in the Emergency Department (ED), in order to meet the therapeutic goals of the Surviving Sepsis Campaign (SSC).Aim: To improve initial sepsis care at the ED by identifying biomarkers for risk stratification and by a region-wide implementation of the novel triage model Sepsis Alert.
Methods: In the first study we retrospectively evaluated the implementation of the Sepsis Alert at the ED, SUS Malmö. The second study was a post-hoc analysis of the biomarker mid-regional proadrenomedullin (MR-proADM) ́s ability to guide antibiotic administration at the ED. In the third study, a prospective observational study, we investigated the biomarker proenkephalin A 119-159 (penKid) as a predictor of acute kidney injury, multi-organ failure (MOF) and mortality in unselected sepsis patients at the ED. The fourth study was a before-and-after multicenter study to assess whether the Sepsis Alert resulted in improved initial care of patients with severe infections at the ED.
Results: We found that the implementation of Sepsis Alert led to shorter time to (appropriate) antibiotics, improvement of quality markers of sepsis care in accordance with SSC, and decreased length of hospital stay. Also, in a subgroup of 5/8 EDs, ICU care decreased after the intervention (Studies I & IV). In Study II, MR-proADM on arrival at the ED had the strongest association with the requirement for antibiotic administration, compared to other biomarkers. Also, ICU care and 28-day mortality was zero in patients with low concentrations of MR-proADM. In study III, penKid in unselected sepsis patients at the ED significantly predicted progression from renal-SOFA ≤ 1 to higher renal-SOFA scores, MOF, and mortality.
Conclusions: The triage model Sepsis Alert improves sepsis care and is today an integrated part of the daily routine at the EDs in Skåne Region, and the experiences from this work are applied in the national mandatory guidelines “Personcentrerat och sammanhållet vårdförlopp för sepsis”. Moreover, the biomarker studied in this thesis may identify sepsis patients with good (low MR-proADM), and poor (high penKid) prognosis. (Less)
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author
supervisor
opponent
  • Docent Ternhag, Anders, Karolinska Institutet
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Sepsis, Emergency Department, biomarkers, MR-proADM, penKid, triage, Sepsis Alert, implementation
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
issue
2021:76
pages
137 pages
publisher
Lund University, Faculty of Medicine
defense location
Föreläsningssal Medelhavet på Wallenberglaboratoriet, Malmö. Join by Zoom: https://lu-se.zoom.us/j/69111737587
defense date
2021-09-03 13:00:00
ISSN
1652-8220
ISBN
978-91-8021-082-9
language
English
LU publication?
yes
id
74fc5570-e840-4d85-84ba-6e048ae7e448
date added to LUP
2021-08-10 07:54:46
date last changed
2021-09-20 12:47:56
@phdthesis{74fc5570-e840-4d85-84ba-6e048ae7e448,
  abstract     = {{Background: Sepsis, the life-threatening organ dysfunction due to dysregulated host response to an infection, is a medical emergency. Early diagnosis and treatment are important factors to prevent mortality and morbidity. However, sepsis can be diffuse and difficult to interpret. Therefore, it is important to define models for early identification applicable in the Emergency Department (ED), in order to meet the therapeutic goals of the Surviving Sepsis Campaign (SSC).Aim: To improve initial sepsis care at the ED by identifying biomarkers for risk stratification and by a region-wide implementation of the novel triage model Sepsis Alert. <br>
Methods: In the first study we retrospectively evaluated the implementation of the Sepsis Alert at the ED, SUS Malmö. The second study was a post-hoc analysis of the biomarker mid-regional proadrenomedullin (MR-proADM) ́s ability to guide antibiotic administration at the ED. In the third study, a prospective observational study, we investigated the biomarker proenkephalin A 119-159 (penKid) as a predictor of acute kidney injury, multi-organ failure (MOF) and mortality in unselected sepsis patients at the ED. The fourth study was a before-and-after multicenter study to assess whether the Sepsis Alert resulted in improved initial care of patients with severe infections at the ED. <br>
Results: We found that the implementation of Sepsis Alert led to shorter time to (appropriate) antibiotics, improvement of quality markers of sepsis care in accordance with SSC, and decreased length of hospital stay. Also, in a subgroup of 5/8 EDs, ICU care decreased after the intervention (Studies I &amp; IV). In Study II, MR-proADM on arrival at the ED had the strongest association with the requirement for antibiotic administration, compared to other biomarkers. Also, ICU care and 28-day mortality was zero in patients with low concentrations of MR-proADM. In study III, penKid in unselected sepsis patients at the ED significantly predicted progression from renal-SOFA ≤ 1 to higher renal-SOFA scores, MOF, and mortality. <br>
Conclusions: The triage model Sepsis Alert improves sepsis care and is today an integrated part of the daily routine at the EDs in Skåne Region, and the experiences from this work are applied in the national mandatory guidelines “Personcentrerat och sammanhållet vårdförlopp för sepsis”. Moreover, the biomarker studied in this thesis may identify sepsis patients with good (low MR-proADM), and poor (high penKid) prognosis.}},
  author       = {{Rosenqvist, Mari}},
  isbn         = {{978-91-8021-082-9}},
  issn         = {{1652-8220}},
  keywords     = {{Sepsis; Emergency Department; biomarkers; MR-proADM; penKid; triage; Sepsis Alert; implementation}},
  language     = {{eng}},
  number       = {{2021:76}},
  publisher    = {{Lund University, Faculty of Medicine}},
  school       = {{Lund University}},
  series       = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
  title        = {{Sepsis - an ED perspective. Sepsis Alert & Biomarkers.}},
  url          = {{https://lup.lub.lu.se/search/files/101142247/Mari_Rosenqvist_web.pdf}},
  year         = {{2021}},
}