Gianni Turcato1, Arian Zaboli2, Laura Ciccariello2, Norbert Pfeifer2. 1. Department of Emergency Medicine, Franz Tappeiner General Hospital of Merano, Azienda Sanitaria dell'Alto Adige, Merano, Italy. Electronic address: gianni.turcato@yahoo.it. 2. Department of Emergency Medicine, Franz Tappeiner General Hospital of Merano, Azienda Sanitaria dell'Alto Adige, Merano, Italy.
Abstract
INTRODUCTION: Capillary permeability can be increased in patients with sepsis. Indirect estimation of plasma volume status (ePVS) could identify more severely ill patients with fever. METHODS: 1502 patients evaluated for fever at the Emergency Department (ED) of Merano General Hospital (Italy) between June 1, 2018 and May 30, 2019. The ePVS value registered on ED admission and derived from complete blood count was considered. Associations between the ePVS value and the two outcomes of the study (30-day mortality and sepsis diagnosis) were studied. RESULTS: Fifty-one of 1502 patients (3.4%) died at 30 days and 5.3% (80/1502) had a diagnosis of sepsis. The median ePVS in patients who died was higher than in those who survived (6.01 dL/g vs 4.49 dL/g, p < .001). In the multivariate analysis, ePVS higher than 4.52 dL/g presented an OR of 2.717 (CI95% 1.103-6.692, p = .020) for 30-day mortality and 1.824 (CI95% 1.055-3.154, p = .030) for the diagnosis of sepsis. ePVS presented a significant improvement in reclassification of the usual evaluation of patients with fever (NRI 21.6% for 30-day mortality and NRI 19.7 for sepsis diagnosis, p < .001). CONCLUSION: The ePVS value was a useful additional predictive tool to assess the severity of illness in patients with fever.
INTRODUCTION: Capillary permeability can be increased in patients with sepsis. Indirect estimation of plasma volume status (ePVS) could identify more severely ill patients with fever. METHODS: 1502 patients evaluated for fever at the Emergency Department (ED) of Merano General Hospital (Italy) between June 1, 2018 and May 30, 2019. The ePVS value registered on ED admission and derived from complete blood count was considered. Associations between the ePVS value and the two outcomes of the study (30-day mortality and sepsis diagnosis) were studied. RESULTS: Fifty-one of 1502 patients (3.4%) died at 30 days and 5.3% (80/1502) had a diagnosis of sepsis. The median ePVS in patients who died was higher than in those who survived (6.01 dL/g vs 4.49 dL/g, p < .001). In the multivariate analysis, ePVS higher than 4.52 dL/g presented an OR of 2.717 (CI95% 1.103-6.692, p = .020) for 30-day mortality and 1.824 (CI95% 1.055-3.154, p = .030) for the diagnosis of sepsis. ePVS presented a significant improvement in reclassification of the usual evaluation of patients with fever (NRI 21.6% for 30-day mortality and NRI 19.7 for sepsis diagnosis, p < .001). CONCLUSION: The ePVS value was a useful additional predictive tool to assess the severity of illness in patients with fever.