Usefulness of ischemia-modified albumin in the diagnosis of sepsis/septic shock in the emergency department

Seung Hwa Choo, Yong Su Lim, Jin Seong Cho, Jae Ho Jang, Jea Yeon Choi, Woo Sung Choi, Hyuk Jun Yang, Seung Hwa Choo, Yong Su Lim, Jin Seong Cho, Jae Ho Jang, Jea Yeon Choi, Woo Sung Choi, Hyuk Jun Yang

Abstract

Objective: No studies have evaluated the diagnostic value of ischemia-modified albumin (IMA) for the early detection of sepsis/septic shock in patients presenting to the emergency department (ED). We aimed to assess the usefulness of IMA in diagnosing sepsis/septic shock in the ED.

Methods: This retrospective, observational study analyzed IMA, lactate, high sensitivity C-reactive protein, and procalcitonin levels measured within 1 hour of ED arrival. Patients with suspected infection meeting at least two systemic inflammatory response syndrome criteria were included and classified into the infection, sepsis, and septic shock groups using Sepsis-3 definitions. Areas under the receiver operating characteristic curves (AUCs) with 95% confidence intervals (CIs) and multivariate logistic regression were used to determine diagnostic performance.

Results: This study included 300 adult patients. The AUC (95% CI) of IMA levels (cut-off ≥85.5 U/mL vs. ≥87.5 U/mL) was higher for the diagnosis of sepsis than for that of septic shock (0.729 [0.667-0.791] vs. 0.681 [0.613-0.824]) and was higher than the AUC of procalcitonin levels (cut-off ≥1.58 ng/mL, 0.678 [0.613-0.742]) for the diagnosis of sepsis. When IMA and lactate levels were combined, the AUCs were 0.815 (0.762-0.867) and 0.806 (0.754-0.858) for the diagnosis of sepsis and septic shock, respectively. IMA levels independently predicted sepsis (odds ratio, 1.05; 95% CI, 1.00-1.09; P=0.029) and septic shock (odds ratio, 1.07; 95% CI, 1.02-1.11; P=0.002).

Conclusion: Our findings indicate that IMA levels are a useful biomarker for diagnosing sepsis/septic shock early, and their combination with lactate levels can enhance the predictive power for early diagnosis of sepsis/septic shock in the ED.

Keywords: Biomarkers; Ischemia-modified albumin; Sepsis; Shock, septic.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Flow chart of patient selection based on inclusion and exclusion criteria. ED, emergency department; SIRS, systemic inflammatory response syndrome; IMA, ischemia-modified albumin; PCT, procalcitonin; hsCRP, high sensitivity C-reactive protein; PCAS, post cardiac arrest syndrome; PTE, pulmonary thromboembolism.
Fig. 2.
Fig. 2.
Comparison of the receiver operating characteristic curves of ischemia-modified albumin (IMA), procalcitonin (PCT), lactate, and high sensitivity C-reactive protein (hsCRP) levels for the prediction of (A) sepsis and (B) septic shock. AUC, area under receiver operating characteristic curve; CI, confidence interval.
Fig. 3.
Fig. 3.
Comparison of receiver operating characteristic curves of procalcitonin (PCT), lactate, and high sensitivity C-reactive protein (hsCRP) levels, and quick sepsis-related organ failure assessment (qSOFA) score combined with ischemia-modified albumin (IMA) levels for (A) sepsis and (B) septic shock prediction. AUC, area under receiver operating characteristic curve; CI, confidence interval.

References

    1. Dellinger RP, Carlet JM, Masur H, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med. 2004;32:858–73.
    1. Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med. 2008;34:17–60.
    1. Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39:165–228.
    1. Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2017;45:486–552.
    1. Martin GS. Sepsis, severe sepsis and septic shock: changes in incidence, pathogens and outcomes. Expert Rev Anti Infect Ther. 2012;10:701–6.
    1. Beal AL, Cerra FB. Multiple organ failure syndrome in the 1990s: systemic inflammatory response and organ dysfunction. JAMA. 1994;271:226–33.
    1. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368–77.
    1. Puskarich MA, Marchick MR, Kline JA, Steuerwald MT, Jones AE. One year mortality of patients treated with an emergency department based early goal directed therapy protocol for severe sepsis and septic shock: a before and after study. Crit Care. 2009;13:R167.
    1. Chamberlain DJ, Willis E, Clark R, Brideson G. Identification of the severe sepsis patient at triage: a prospective analysis of the Australasian Triage Scale. Emerg Med J. 2015;32:690–7.
    1. Lippi G, Montagnana M, Balboni F, et al. Academy of Emergency Medicine and Care-Society of Clinical Biochemistry and Clinical Molecular Biology consensus recommendations for clinical use of sepsis biomarkers in the emergency department. Emerg Care J. 2017;13:6877.
    1. Schmidt de Oliveira-Netto AC, Morello LG, Dalla-Costa LM, et al. Procalcitonin, C-reactive protein, albumin, and blood cultures as early markers of sepsis diagnosis or predictors of outcome: a prospective analysis. Clin Pathol. 2019;12:2632010X19847673.
    1. Luzzani A, Polati E, Dorizzi R, Rungatscher A, Pavan R, Merlini A. Comparison of procalcitonin and C-reactive protein as markers of sepsis. Crit Care Med. 2003;31:1737–41.
    1. Ljungstrom L, Pernestig AK, Jacobsson G, Andersson R, Usener B, Tilevik D. Diagnostic accuracy of procalcitonin, neutrophillymphocyte count ratio, C-reactive protein, and lactate in patients with suspected bacterial sepsis. PLoS One. 2017;12:e0181704.
    1. Bakker J, Gris P, Coffernils M, Kahn RJ, Vincent JL. Serial blood lactate levels can predict the development of multiple organ failure following septic shock. Am J Surg. 1996;171:221–6.
    1. Miglietta F, Faneschi ML, Lobreglio G, et al. Procalcitonin, Creactive protein and serum lactate dehydrogenase in the diagnosis of bacterial sepsis, SIRS and systemic candidiasis. Infez Med. 2015;23:230–7.
    1. Hausfater P, Juillien G, Madonna-Py B, Haroche J, Bernard M, Riou B. Serum procalcitonin measurement as diagnostic and prognostic marker in febrile adult patients presenting to the emergency department. Crit Care. 2007;11:R60.
    1. Bar-Or D, Curtis G, Rao N, Bampos N, Lau E. Characterization of the Co(2+) and Ni(2+) binding amino-acid residues of the N-terminus of human albumin: an insight into the mechanism of a new assay for myocardial ischemia. Eur J Biochem. 2001;268:42–7.
    1. Bar-Or D, Lau E, Winkler JV. A novel assay for cobalt-albumin binding and its potential as a marker for myocardial ischemiaa preliminary report. J Emerg Med. 2000;19:311–5.
    1. Sinha MK, Roy D, Gaze DC, Collinson PO, Kaski JC. Role of “Ischemia modified albumin”, a new biochemical marker of myocardial ischaemia, in the early diagnosis of acute coronary syndromes. Heart. 2004;90:644.
    1. Lin S, Yokoyama H, Rac VE, Brooks SC. Novel biomarkers in diagnosing cardiac ischemia in the emergency department: a systematic review. Resuscitation. 2012;83:684–91.
    1. Abboud H, Labreuche J, Meseguer E, et al. Ischemia-modified albumin in acute stroke. Cerebrovasc Dis. 2007;23:216–20.
    1. Balta S, Alemdar R, Erdogan S, Demir M, Ozturk C, Celik T. Ischemia modified albumin in cardiovascular disease. Am J Emerg Med. 2016;34:1699.
    1. Montagnana M, Danese E, Lippi G. Biochemical markers of acute intestinal ischemia: possibilities and limitations. Ann Transl Med. 2018;6:341.
    1. Turedi S, Gunduz A, Mentese A, et al. The value of ischemiamodified albumin compared with d-dimer in the diagnosis of pulmonary embolism. Respir Res. 2008;9:49.
    1. Erdem SS, Yerlikaya FH, Cicekler H, Gul M. Association between ischemia-modified albumin, homocysteine, vitamin B(12) and folic acid in patients with severe sepsis. Clin Chem Lab Med. 2012;50:1417–21.
    1. Prashanth AK, Anand U. Clinical significance of ischemia modified albumin in critically ill patients with sepsis. Indian J Clin Biochem. 2015;30:194–7.
    1. Ashok Kumar P, Anand U. Multiple biomarkers to assess the pathophysiological state in critically ill patients with sepsis. Indian J Clin Biochem. 2016;31:310–4.
    1. Khashana A, Ayoub A, Younes S, Abdelrahman A. Ischemia modified albumin in early neonatal sepsis. Infect Dis (Lond) 2016;48:488–9.
    1. Yerlikaya FH, Kurban S, Mehmetoglu I, et al. Serum ischemiamodified albumin levels at diagnosis and during treatment of late-onset neonatal sepsis. J Matern Fetal Neonatal Med. 2014;27:1723–7.
    1. Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) JAMA. 2016;315:801–10.
    1. Rodriguez RM, Greenwood JC, Nuckton TJ, et al. Comparison of qSOFA with current emergency department tools for screening of patients with sepsis for critical illness. Emerg Med J. 2018;35:350–6.
    1. Galley HF. Bench-to-bedside review: targeting antioxidants to mitochondria in sepsis. Crit Care. 2010;14:230.
    1. Weiss SL, Deutschman CS. Elevated malondialdehyde levels in sepsis: something to ‘stress’ about? Crit Care. 2014;18:125.
    1. Freund Y, Delerme S, Goulet H, Bernard M, Riou B, Hausfater P. Serum lactate and procalcitonin measurements in emergency room for the diagnosis and risk-stratification of patients with suspected infection. Biomarkers. 2012;17:590–6.
    1. Nguyen HB, Rivers EP, Knoblich BP, et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med. 2004;32:1637–42.
    1. Zapico-Muniz E, Santalo-Bel M, Merce-Muntanola J, Montiel JA, Martinez-Rubio A, Ordonez-Llanos J. Ischemia-modified albumin during skeletal muscle ischemia. Clin Chem. 2004;50:1063–5.
    1. Williams JM, Greenslade JH, McKenzie JV, Chu K, Brown AF, Lipman J. Systemic inflammatory response syndrome, quick sequential organ function assessment, and organ dysfunction: insights from a prospective database of ED patients with infection. Chest. 2017;151:586–96.
    1. Singer AJ, Ng J, Thode HC, Jr, Spiegel R, Weingart S. Quick SOFA scores predict mortality in adult emergency department patients with and without suspected infection. Ann Emerg Med. 2017;69:475–9.
    1. Dorsett M, Kroll M, Smith CS, Asaro P, Liang SY, Moy HP. qSOFA has poor sensitivity for prehospital identification of severe sepsis and septic shock. Prehosp Emerg Care. 2017;21:489–97.
    1. Shetty A, MacDonald SP, Williams JM, et al. Lactate ≥2 mmol/L plus qSOFA improves utility over qSOFA alone in emergency department patients presenting with suspected sepsis. Emerg Med Australas. 2017;29:626–34.
    1. Spoto S, Cella E, de Cesaris M, et al. Procalcitonin and MRproadrenomedullin combination with SOFA and qSOFA scores for sepsis diagnosis and prognosis: a diagnostic algorithm. Shock. 2018;50:44–52.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren