title: Are prognostic scores and biomarkers such as procalcitonin the appropriate prognostic precursors for elderly patients with sepsis in the emergency department?
abstract: BACKGROUND
  The mortality of patients with severe sepsis and septic shock is still high, and the prognosis of elderly patients tends to be particularly poor. Therefore, this study sought to conduct a comparative analysis of the abbreviated mortality in emergency department sepsis (abbMEDS) score, sequential organ failure assessment (SOFA) score, infection probability score (IPS), initial procalcitonin (PCT), and cytokine levels to investigate the effectiveness of each index in predicting the prognosis of elderly patients with sepsis in the emergency department (ED).
  
  
  METHODS
  This was a single-center prospective study, and classified 55 patients (≥65 years of age) with systemic inflammatory response syndrome (SIRS) from January 2013 to December 2013 in the ED. A total of 36 elderly patients were diagnosed with sepsis. The prediction of prognosis using the prognostic scores (abbMEDS, SOFA, IPS) was analyzed. An early blood examination (WBC count, C-reactive protein, PCT, and cytokines) was conducted within the first 2 h of the patient's arrival at the ED.
  
  
  RESULTS
  The median (IQR) age of subjects was 76.5 (70.5-81.5). After 28 days, 27 subjects (75 %) had survived, and 9 (25 %) had died. Fifteen (41.7 %) were sent to intensive care units (ICUs). The SOFA score and abbMEDS showed higher median (IQR) values of 9.5 (7.0-11.0) and 13.5 (12.0-15.0), respectively, in the ICU group than in the general ward group (p < 0.001). Analysis of the levels of PCT, IL-10, IL-6, and IL-5 had a significantly better ability to predict ICU admission (p = 0.001, p = 0.023, p = 0.030, p = 0.001). The prediction of mortality in the first 28 days via SOFA and the abbMEDS resulted in scores of 11.0 (8.0-11.0) and 14.0 (12.5-15.5) (p = 0.004, p = 0.003), respectively. However, levels of IPS, PCT, and cytokines did not show significant differences.
  
  
  CONCLUSIONS
  In predicting ICU admission and the death of elderly sepsis patients in ED, SOFA and abbMEDS scores were effective. Of the various biomarkers, PCT, IL-10, IL-6, and IL-5 were effective in predicting ICU admission, but were not effective in predicting the death of elderly sepsis patients.
authors.affiliation: Department of Emergency Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #665-8 Bupyeong 6-dong, Bupyeong-gu, Incheon, 403-720, Republic of Korea.
authors.forename: Woon Jeong
authors.initials: WJ
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #665-8 Bupyeong 6-dong, Bupyeong-gu, Incheon, 403-720, Republic of Korea. drme@catholic.ac.kr.
authors.forename: Seon Hee
authors.initials: SH
authors.lastname: Woo
authors.affiliation: Department of Emergency Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #665-8 Bupyeong 6-dong, Bupyeong-gu, Incheon, 403-720, Republic of Korea.
authors.forename: Dae Hee
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #665-8 Bupyeong 6-dong, Bupyeong-gu, Incheon, 403-720, Republic of Korea.
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Seol
authors.affiliation: Department of Emergency Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #665-8 Bupyeong 6-dong, Bupyeong-gu, Incheon, 403-720, Republic of Korea.
authors.forename: Si Kyung
authors.initials: SK
authors.lastname: Park
authors.affiliation: Department of Emergency Medicine, Yeouido St. Mary`s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Seung Pill
authors.initials: SP
authors.lastname: Choi
authors.affiliation: Department of Laboratory Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Jekarl
authors.affiliation: Department of Laboratory Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Seung Ok
authors.initials: SO
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000378:metabolism*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016753:Interleukin-10 / Q000032:analysis; D015850:Interleukin-6 / Q000032:analysis; D007958:Leukocyte Count; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000503:physiopathology*; D018746:Systemic Inflammatory Response Syndrome / Q000503:physiopathology*
chemical_list: D015415:Biomarkers; C508609:IL10 protein, human; D015850:Interleukin-6; D016753:Interleukin-10; D002116:Calcitonin; D002097:C-Reactive Protein
keywords: Elderly; Emergencies; Procalcitonin; Prognosis; Sepsis