title: Outcome prediction using clinical scores and biomarkers in patients with presumed severe infection in the emergency department.
abstract: BACKGROUND
  Severe infections play an important role in the emergency department (ED) and early risk stratification is essential. We compared the prognostic value of APACHE II, SOFA, and MEDS scores, and the biomarkers C-reactive protein (CRP), procalcitonin (PCT), and interleukin 6 (IL-6).
  
  
  METHODS
  We performed a prospective observational study. Patients aged 18 years or older with a severe infection, from whom blood cultures were taken, were included.
  
  
  RESULTS
  Two hundred and eleven patients were included. The 30-day mortality rate was 8.5%. All scores and biomarkers showed significant area under the curve (AUC) values of receiver operating characteristic curve analysis for death within 30 days: 0.801 for APACHE II, 0.785 for MEDS, 0.708 for SOFA, 0.693 for CRP, 0.651 for PCT, and 0.716 for IL-6. For treatment in an ICU and need for mechanical ventilation, these parameters had significant AUC values, too. For renal replacement therapy, only APACHE II, SOFA, and PCT showed significant AUC values. According to the trend observed, the AUC values were highest for the APACHE II score.
  
  
  CONCLUSIONS
  All investigated parameters have a predictive value in patients with an infection in the ED. According to the trend observed, the APACHE II score seems to have the best discriminative power. Use of the APACHE II score already at the time of admission to the ED may be useful for stratifying patients at risk for ICU treatment, thereby using the same score in the ED and the ICU.
authors.affiliation: Department of Medicine III, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Ernst-Grube-Strasse 40, Halle (Saale), Germany. joachim.wilhelm@uk-halle.de
authors.forename: J
authors.initials: J
authors.lastname: Wilhelm
authors.forename: S
authors.initials: S
authors.lastname: Hettwer
authors.forename: D
authors.initials: D
authors.lastname: Hammer
authors.forename: M
authors.initials: M
authors.lastname: Schürmann
authors.forename: A
authors.initials: A
authors.lastname: Christoph
authors.forename: M
authors.initials: M
authors.lastname: Amoury
authors.forename: T
authors.initials: T
authors.lastname: Klöss
authors.forename: R
authors.initials: R
authors.lastname: Finke
authors.forename: H
authors.initials: H
authors.lastname: Ebelt
authors.forename: K
authors.initials: K
authors.lastname: Werdan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D015897:Comorbidity; D004636:Emergency Service, Hospital; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D018805:Sepsis / Q000145:classification / Q000175:diagnosis* / Q000401:mortality*; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers