title: Trends in vital signs and routine biomarkers in patients with sepsis during resuscitation in the emergency department: a prospective observational pilot study.
abstract: Sepsis lacks a reliable and readily available measure of disease activity. Thereby, it remains unclear how to monitor response to treatment. Research on numerous (new) biomarkers associated with sepsis provided disappointing results and little is known about changes in vital signs during sepsis resuscitation. We hypothesised that trends in vital signs together with routine biomarker levels during resuscitation might provide information about the response to treatment at a very early stage of sepsis in the emergency department (ED). We therefore explore trends in vital signs and routine biomarker levels during sepsis resuscitation in the ED.
  
  
  
  Prospective observational pilot study.
  
  
  
  ED of a tertiary care teaching hospital.
  
  
  
  99 Adult non-trauma patients with suspected infection and 2 or more systemic inflammatory response syndrome criteria admitted to the ED.
  
  
  
  Vital signs and biomarker levels at admittance (T0) and after 3 h in the ED (T1).
  
  
  
  In total, data of 99 patients were analysed. Of these patients, 63 presented with sepsis, 30 with severe sepsis and 6 with septic shock. All vital signs decreased, except for peripheral oxygen saturation which increased. Almost all routine biomarker levels decreased during resuscitation, except for C reactive protein, bands, potassium, troponin T and direct bilirubin which remained stable. Sodium, chloride and N-terminal prohormone of brain natriuretic peptide increased slightly.
  
  
  
  Vital signs and biomarker levels showed descending trends during resuscitation, except for parameters directly affected by treatment modalities. Despite these trends, most patients improved clinically. Trends in vital signs and routine biomarkers might be helpful in predicting clinical course and response to treatment in patients with sepsis during early resuscitation.
authors.affiliation: Department of Emergency Medicine, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Vincent M
authors.initials: VM
authors.lastname: Quinten
authors.affiliation: Department of Critical Care, University Medical Center Groningen, Groningen, The Netherlands Department of Pathology and Medical Biology, Medical Biology Section, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Matijs
authors.initials: M
authors.lastname: van Meurs
authors.affiliation: Department of Emergency Medicine, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Jan C
authors.initials: JC
authors.lastname: Ter Maaten
authors.affiliation: Department of Emergency Medicine, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Jack J M
authors.initials: JJ
authors.lastname: Ligtenberg
mesh_terms: D000328:Adult; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000494:pharmacology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000494:pharmacology; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000378:metabolism*; D002712:Chlorides / Q000097:blood; D015897:Comorbidity; D004232:Diuretics / Q000494:pharmacology; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010100:Oxygen / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D010865:Pilot Projects; D011188:Potassium / Q000097:blood; D011446:Prospective Studies; D012151:Resuscitation; D018805:Sepsis / Q000097:blood / Q000503:physiopathology* / Q000628:therapy*; D012772:Shock, Septic / Q000503:physiopathology / Q000628:therapy; D012964:Sodium / Q000097:blood; D020107:Troponin T / Q000097:blood; D055986:Vital Signs / Q000187:drug effects
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000894:Anti-Inflammatory Agents, Non-Steroidal; D015415:Biomarkers; D002712:Chlorides; D004232:Diuretics; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein; D012964:Sodium; D001663:Bilirubin; D011188:Potassium; D010100:Oxygen
keywords: ACCIDENT & EMERGENCY MEDICINE; CLINICAL PHYSIOLOGY; INFECTIOUS DISEASES