243 Host response severity score for intensive care unit-level care prediction in emergency patients with suspected sepsis

Document Type

Conference Proceeding

Publication Date

5-13-2024

Publication Title

Acad Emerg Med

Abstract

Background and Objectives: For patients presenting to the ED with acute infections and/or suspected sepsis, accurate risk stratification is challenging. Physician judgment based on clinical exam, clinical scores and limited diagnostics are standard of care. There is a new blood-based host response test (in development) using the SEV-4 classifier to predict 7 day ICU level care. We evaluated the accuracy of the test to predict ICU level care (mechanical ventilation, vasopressors and/or renal replacement therapy) compared to initial physician impression and qSOFA scores. Methods: Adults presenting to 7 EDs with suspected acute infections or sepsis with ?1 abnormal vital sign were enrolled (PILOT, NCT03744741). At enrollment, treating physicians estimated risk of severe outcome (low, low-moderate, moderate-high, or high) and qSOFA scores were collected. The SEV-4 classifier test was performed from a blood RNA tube and results were expressed in 5 discrete interpretation bands (very low, low, moderate, high, very high). Sensitivity, specificity and likelihood ratios (LR) were calculated for dichotomized risk estimations combined with qSOFA ‘low risk SoC’ (LR-SoC) and ‘high risk SoC’ (HR-SoC) groups and SEV-4 results vs. ICU-level care. Results: 517 eligible patients had a physician questionnaire, and 41 patients required ICU level care or admission within 7 days. LR of physician risk estimates were (from low to high) 0.56 / 1.79 / 1.62 / 4.77, with a specificity of 0.97 (high) and sensitivity of 0.61 (low). LR of qSOFA were (from 0 to 3) 0.4 / 1.5 / 2.3 / 38.5, with a specificity of 1.00 (qSOFA?=?3) and sensitivity of 0.76 (qSOFA=0). LR of SEV-4 bands for 7-day ICU care prediction were (very low to very high) 0.18 / 1.12 / 2.10 / 3.38 / 7.70, with a specificity of 0.98 (very high) and sensitivity of 0.90 (very low). Of 92 HR-SoC patients, 14 (15%) needed 7-day ICU care, compared to 22 (5.2%) of 425 LR-SoC patients (p?=?0.0006). Among 22 cases with low physician estimation / low qSOFA needing 7-day ICU care, SEV-4 identified 13 (59%) cases with moderate to very high scores that would have been missed. Conclusion: SEV-4 identifies patients with low physician risk estimates and low qSOFA scores that would progress to ICU level care within 7 days. The test could enable earlier re-examination and treatment in a well-appearing group.

Volume

31

Issue

S1

First Page

119

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