Screening and Risk Stratification of Patients with Suspected Bacterial Sepsis in the Adult Emergency Department

Abstract

Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. It affects millions of people worldwide every year, potentially leading to numerous deaths, with the burden most likely in low- and middle-income countries. Most hospital patients suffering from sepsis in high-income countries are admitted through emergency departments. The need for timely investigations and interventions require that clinicians and systems implement screening pathways in emergency departments to better risk stratify patients who present with infection. Recently, sepsis definitions have changed to reflect the pathophysiology and role of organ dysfunction in propagating adverse outcomes in patients who have infection (Publication 1. Review article: Sepsis in the emergency department - Part 1: Definitions and outcomes. Publication 2. New sepsis definition changes incidence of sepsis in the intensive care unit.). International big dataset investigations have promulgated the use of rapid bedside screening tools in hospitals but my investigations support several other recent evaluations casting doubts on the performance of these tools (Publication 3. Systemic inflammatory response syndrome-based severe sepsis screening algorithms in emergency department patients with suspected sepsis. Publication 4. Accuracy of qSOFA to predict sepsis mortality in 121 studies including 1,716,017 individuals; a systematic review and meta-analysis Publication 5. Comparison of the Quick Sepsis-Related Organ Failure Assessment (qSOFA) and Adult Sepsis Pathway in Predicting Adverse Outcomes among Adult Patients on General Wards: A Retrospective Observational Cohort Study. Publication 6. The association between systolic blood pressure and in-hospital mortality in older emergency department patients who are hospitalised with a suspected infection). Screening for diseases at risk for serious require very high sensitivity and inadequately sensitive tools result in lack of clinician trust which can lead to over-prescribing of investigations and broad-spectrum antibiotics. My research has highlighted issues with binomial cut-offs including phenotypic variations for variables in screening algorithms (Publication 3. Systemic inflammatory response syndrome-based severe sepsis screening algorithms in emergency department patients with suspected sepsis. Publication 6. The association between systolic blood pressure and in-hospital mortality in older emergency department patients who are hospitalised with a suspected infection) and also shown that including certain existing and rapidly available novel biomarkers’ cut-offs could help improve the sensitivity of algorithms (Publication 7. Serum lactate cut-offs as a risk stratification tool for in-hospital adverse outcomes in emergency department patients screened for suspected sepsis. Publication 8. Arterial to end-tidal carbon dioxide tension difference (CO2 gap) as a prognostic marker for adverse outcomes in emergency department patients presenting with suspected sepsis Publication 9. Review article: Sepsis in the emergency department - Part 2: Investigations and monitoring. Publication 10. Procoagulant platelets as a biomarker in suspected sepsis - a pilot study. Publication 11. New Assay for Bacterial Load and Sepsis Mortality (BLISS STUDY) Publication 12. Multiplex tandem Real time-PCR assay in whole blood samples from Emergency Department patients presenting with suspected sepsis. (in preparation) Publication 13. Lactate ≥2 mmol/L plus qSOFA improves utility over qSOFA alone in emergency department patients presenting with suspected sepsis. Publication 14. The addition of inflammatory marker threshold to the Lactate quick SOFA score improves its sensitivity at predicting adverse outcomes in emergency department suspected sepsis patients. (in review))