CLINICAL VALUE OF TWO SCORING SYSTEMS, C-REACTIVE PROTEIN AND LACTATE CLEARANCE IN PATIENTS WITH SEVERE SEPSIS AT THE EMERGENCY DEPARTMENT

1) Department of Emergency medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.

2) Department of Anesthesia and Intensive Care, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.

Disclosure: The author has declared no conflicts of interest.

Received: 20.03.16 Accepted: 18.04.16

Citation: 10.5455/ijsm.severesepsis

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Abstract:

Introduction: More recently the grading system of sepsis was modified to include severe sepsis, septic shock, and refractory septic shock. Several indexes were found to be significantly related to short-term clinical outcome; as sequential organ failure assessment score (SOFA) and the mortality in emergency department sepsis (MEDS) score.
Methods: Observational cohort study with prospective data collection. Severity of sepsis was assessed according to SOFA score, MEDS score. C-reactive protein (CRP) and 6 hours lactate clearance were measured. The outcome of patients was noticed according to the detected SOFA score, MEDS score, CRP, and lactate clearance levels in the survivors and non-survivors as well as their correlation with the severity of the disease.
Results: Fifty patients with age range from 20 to 92 years. The mortality rate was 24% (12 patients). Six hours lactate clearance mean value was 21.04 ± 9.48%. Mean SOFA score at presentation was 6.56 ± 2.99 while after 72 hours, it was 5.28 ± 3.94. Mean MEDS score was 2.72. Six hours lactate clearance was significantly lower among the dead cases. MEDS score was significantly higher among the mortality cases. SOFA score whether measured at admission or after 72 hours and MEDS score were significantly higher among the dead cases. Both delta SOFA score and 6 hour lactate clearance were found to have the highest predictive characteristics with 100% sensitivity and specificity. There was statistically significant difference between area under the curve of SOFA 72 hours and 6 hours-lactate clearance when compared to CRP area under the curve.
Conclusion: Both delta SOFA score and six hour lactate clearance had the highest predictive characteristics with 100% sensitivity and specificity.

Keywords: SOFA score, MEDS score, 6hs lactate clearance, severe sepsis.