The Role of several Biomarkers and Scoring Systems Assessed During Emergency Department Admission Day in Predicting Septic Shock

Sepsis results in a life-threatening organ dysfunction due to the dysregulation of organ dysfunction detection, risk stratification, prognosis, and treatment is crucial for sepsis and septic shock. Several widely-available biomarkers are including white blood cells count (WBC), neutrophil-lymphocyte ratio (NLR) C-reactive protein (CRP), and procalcitonin (PCT), lactate levels. Presepsin (P-SEP) and mid-regional pro-adrenomedullin (MR-ProADM), are other two important biomarkers currently under investigation. In addition, clinical scoring system such as the Sequential Organ Failure Assessment (SOFA) and the Acute Physiology and Chronic Health Evaluation (APACHE)-II scores are combined. Furthermore, comorbidities and the underlying infections should be considered. In this study, we evaluated the potency of septic shock predictor in sepsis patients at Dr. Kariadi Hospital Semarang, Indonesia between June and August 2019. A total number of 59 patients, consisted of 19 sepsis and 40 septic shock who fulfilled the Sepsis-3 criteria were enrolled. Biomarkers, scoring system and other variables were evaluated within 24 hours of emergency department (ED admission. Bivariate and multivariate logistic regression analyses as well as receiver operating characteristic curve analysis were used to predict the development of septic shock. A combination of five biomarkers (WBC count, PCT, P-SEP, MR-ProADM, and lactate) plus SOFA score and additional risk variables (skin and soft tissue infection, and hypertension) performed better for predicting septic shock than any single factor.