Janneke Evelyne Stalenhoef1, Cees van Nieuwkoop2, Darius Cameron Wilson3, Willize Elizabeth van der Starre4, Nathalie Manon Delfos5, Eliane Madeleine Sophie Leyten6, Ted Koster7, Hans Christiaan Ablij8, Johannes Jan Willem Van't Wout9, Jaap Tamino van Dissel10. 1. Department of Infectious Diseases, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands. Electronic address: j.e.stalenhoef@lumc.nl. 2. Department of Internal Medicine, Haga Hospital, PO Box 40551, 2504 LN, The Hague, the Netherlands. Electronic address: C.vanNieuwkoop@hagaziekenhuis.nl. 3. Thermo Fisher Scientific, Neuendorfstr. 25, 16761 Hennigsdorf, Germany. Electronic address: Darius.wilson@thermofisher.com. 4. Department of Infectious Diseases, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands. Electronic address: W.E.van_der_Starre@lumc.nl. 5. Department of Internal Medicine, Alrijne Hospital, Postbus 4220, 2350 CC Leiderdorp, the Netherlands. Electronic address: N.Delfos@rijnland.nl. 6. Department of Internal Medicine, MCH-Bronovo, PO Box 432, 2501 CK The Hague, the Netherlands. Electronic address: E.Leyten@mchaaglanden.nl. 7. Department of Internal Medicine, Groene Hart Hospital, PO Box 1098, 2800 BB Gouda, the Netherlands. Electronic address: Ted.Koster@ghz.nl. 8. Department of Internal Medicine, Alrijne Hospital, Postbus 4220, 2350 CC Leiderdorp, the Netherlands. Electronic address: HCAblij@diaconessenhuis.nl. 9. Department of Internal Medicine, MCH-Bronovo, PO Box 432, 2501 CK The Hague, the Netherlands. Electronic address: J.W.van_t_Wout@lumc.nl. 10. Department of Infectious Diseases, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands. Electronic address: J.T.van_Dissel@lumc.nl.
Abstract
OBJECTIVES: Febrile urinary tract infections (fUTI) can often be treated safely with oral antimicrobials in an outpatient setting. However, a minority of patients develop complications that may progress into septic shock. An accurate assessment of disease severity upon emergency department (ED) presentation is therefore crucial in order to guide the most appropriate triage and treatment decisions. METHODS:Consecutive patients were enrolled with presumptive fUTI across 7 EDs in the Netherlands. The biomarkers mid-regional proadrenomedullin (MR-proADM), procalcitonin (PCT), C-reactive protein (CRP), and a clinical score (PRACTICE), were compared in their ability to predict a clinically severe course of fUTI, initial hospital admission and subsequent readmission using area under the receiver operating characteristic (AUROC) curves. RESULTS:Biomarker concentrations were measured in 313 patients, with 259 (83%) hospitalized upon ED presentation, and 54 (17%) treated as outpatients. Of these outpatients, 12 (22%) were later hospitalized. MR-proADM had the highest diagnostic accuracy for predicting a complicated fUTI (AUROC [95% CI]: 0.86 [0.79-0.92]), followed by PCT (AUROC [95% CI]: 0.69 [0.58-0.80]). MR-proADM concentrations were unique in being significantly elevated in patients directly admitted and in outpatients requiring subsequent hospitalization, compared to those completing treatment at home. A virtual triage algorithm with an MR-proADM cut-off of 0.80 nmol/L resulted in a hospitalization rate of 66%, with only 2% secondary admissions. CONCLUSION: MR-proADM could accurately predict a severe course in patients with fUTI, and identify greater patient numbers who could be safely managed as outpatients. An initial assessment on ED presentation may focus resources to patients with highest disease severities.
RCT Entities:
OBJECTIVES:Febrile urinary tract infections (fUTI) can often be treated safely with oral antimicrobials in an outpatient setting. However, a minority of patients develop complications that may progress into septic shock. An accurate assessment of disease severity upon emergency department (ED) presentation is therefore crucial in order to guide the most appropriate triage and treatment decisions. METHODS: Consecutive patients were enrolled with presumptive fUTI across 7 EDs in the Netherlands. The biomarkers mid-regional proadrenomedullin (MR-proADM), procalcitonin (PCT), C-reactive protein (CRP), and a clinical score (PRACTICE), were compared in their ability to predict a clinically severe course of fUTI, initial hospital admission and subsequent readmission using area under the receiver operating characteristic (AUROC) curves. RESULTS: Biomarker concentrations were measured in 313 patients, with 259 (83%) hospitalized upon ED presentation, and 54 (17%) treated as outpatients. Of these outpatients, 12 (22%) were later hospitalized. MR-proADM had the highest diagnostic accuracy for predicting a complicated fUTI (AUROC [95% CI]: 0.86 [0.79-0.92]), followed by PCT (AUROC [95% CI]: 0.69 [0.58-0.80]). MR-proADM concentrations were unique in being significantly elevated in patients directly admitted and in outpatients requiring subsequent hospitalization, compared to those completing treatment at home. A virtual triage algorithm with an MR-proADM cut-off of 0.80 nmol/L resulted in a hospitalization rate of 66%, with only 2% secondary admissions. CONCLUSION: MR-proADM could accurately predict a severe course in patients with fUTI, and identify greater patient numbers who could be safely managed as outpatients. An initial assessment on ED presentation may focus resources to patients with highest disease severities.
Authors: Kordo Saeed; Darius Cameron Wilson; Frank Bloos; Philipp Schuetz; Yuri van der Does; Olle Melander; Pierre Hausfater; Jacopo M Legramante; Yann-Erick Claessens; Deveendra Amin; Mari Rosenqvist; Graham White; Beat Mueller; Maarten Limper; Carlota Clemente Callejo; Antonella Brandi; Marc-Alexis Macchi; Nicholas Cortes; Alexander Kutz; Peter Patka; María Cecilia Yañez; Sergio Bernardini; Nathalie Beau; Matthew Dryden; Eric C M van Gorp; Marilena Minieri; Louisa Chan; Pleunie P M Rood; Juan Gonzalez Del Castillo Journal: Crit Care Date: 2019-02-08 Impact factor: 9.097
Authors: Emanuela Sozio; Nathan A Moore; Martina Fabris; Andrea Ripoli; Francesca Rumbolo; Marilena Minieri; Riccardo Boverio; María Dolores Rodríguez Mulero; Sara Lainez-Martinez; Mónica Martínez Martínez; Dolores Calvo; Claudia Gregoriano; Rebecca Williams; Luca Brazzi; Alessandro Terrinoni; Tiziana Callegari; Marta Hernández Olivo; Patricia Esteban-Torrella; Ismael Calcerrada; Luca Bernasconi; Stephen P Kidd; Francesco Sbrana; Iria Miguens; Kirsty Gordon; Daniela Visentini; Jacopo M Legramante; Flavio Bassi; Nicholas Cortes; Giorgia Montrucchio; Vito N Di Lecce; Ernesto C Lauritano; Luis García de Guadiana-Romualdo; Juan González Del Castillo; Enrique Bernal-Morell; David Andaluz-Ojeda; Philipp Schuetz; Francesco Curcio; Carlo Tascini; Kordo Saeed Journal: Respir Res Date: 2022-08-28