Blood Test Accurately IDs Patients at Low Risk of Sepsis in Emergency Department

March 30, 2022

By Eric Ramos

VIRTUAL -- March 30, 2022 -- A whole blood, multiplex host mRNA expression metric outperformed established risk prediction systems and biomarkers in identifying low-risk patients presenting to the emergency department with suspected infections or sepsis who can safely be discharged, researchers reported at the 41st International Symposium on Intensive Care and Emergency Medicine (ISICEM).

“Unnecessary hospital admission causes increased resource utilisation and may harm patients,” said Eva Diehl-Wiesenecker, MD, Charité - Universitätsmedizin, Berlin, Germany. “Therefore, in patients presenting to the emergency department with suspected infections, the early and reliable identification of those without need for hospitalisation is crucial and remains an unmet medical need.”

Dr. Diehl-Wiesenecker and colleagues evaluated the Inflammatix Severity Classifier Version 2 (IMX-SEV-2) in 312 adult patients presenting to a tertiary care ED with suspected acute infection or sepsis.

Expression of 29 host mRNAs were measured and interpreted with IMX-SEV-2 from whole blood to determine low-, moderate-, or high-risk categories. Results were compared with the clinically adjudicated requirement for hospital-level care based on chart review.

Among the patients, 22 (7.1%) died in hospital, 56 (17.9%) experienced multi-organ failure, and 22 (7.1%) were adjudicated as not requiring hospital care.

IMX-SEV-2 had the highest accuracy for predicting safe discharge (area under the receiver operating characteristic [AUC] = 0.81; 95% confidence interval [CI], 0.76-0.93) when compared with lactate levels (AUC = 0.67; 95% CI, 0.58-0.76), the quick Sequential Organ Failure Assessment (AUC = 0.77; 95% CI, 0.72-0.83), National Early Warning Score 2 (AUC = 0.78; 95% CI, 0.68-0.88), and Confusion, Respiratory Rate, Blood Pressure, Age >65-Score (CRB-65 [AUC = 0.78; 95% CI, 0.70-0.86]).

Among patients with a CRB-65 score <1 who were also classified as low-risk with IMX-SEV-2, only 1 (0.3%) had multi-organ failure and 1 died compared with 9 (2.9%) patients who had multi-organ failure and 3 (1%) who died when only the CRB-65 score as applied.

“Combined with a clinical score like CRB-65, IMX-SEV-2 enhances severity prediction and could support in patient management,” said Dr. Diehl-Wiesenecker.

[Presentation title: Prediction of Safe Discharge of Emergency Department Patients With Suspected Acute Infection Using a 29-mRNA Host Response Test. Abstract A253]