Sequential estimation of the national early warning score-2 and SERUM PRESEPSIN might discriminate sepsis patients who were vulnerable to death in surgical ICU

Abstract

Objectives To evaluate the ability of at-admission (Day 1) estimated serum levels of inflammatory biomarkers and clinical scorings for prediction of survival outcome of sepsis patients admitted to surgical ICU.Patients & Methods One hundred and seventy-eight patients were clinically evaluated and gave blood samples for estimation of serum biomarkers’ levels (Day 1 data) and re-evaluated on Days 2–3 for the National Early Warning-2 (NEWS-2) score and Day 3 for the Sequential organ failure assessment (SOFA) score and serum level of presepsin (PSP). During 28-day, patients were grouped according to survival outcome as Survivors and Non-survivors.Results Day1 clinical scorings and biomarkers’ levels were significantly higher in non-survivors (n = 41) than survivors (n = 137). Day 3 SOFA scores of all patients were significantly higher than Day1 scores with significantly higher scores for non-survivors. Through Day1-3, the number of patients with high-grade risk on NEWS2 was significantly higher among non-survivors. Day-3 serum PSP levels were significantly decreased in survivors, while increased in non-survivors. The statistical analyses defined high NEWS2, SOFA, PSP, and procalcitonin serum levels as the significant predictors of mortality. Diagnostic performance characteristics of combined NEWS score and PSP showed high sensitivity, specificity, and accuracy rates with a 99% negative predictive value for survival outcomes.Conclusion Sequential estimation of NEWS2 score and serum PSP can discriminate between high-risk patients and those prone to die. Coupling of NEWS-2 scoring and estimation of serum PSP allowed more accurate early identification of patients vulnerable to deterioration with high sensitivity and accuracy rates.

Keywords

• Sepsis
• ICU mortality
• the new early warning-2 score
• serum biomarkers
• presepsin