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

Clinical and Experimental Emergency Medicine 2020년 7권 3호 p.161 ~ 169
조시온, 임용수, 조진성, 장재호, 최재연, 최우성, 양혁준,
소속 상세정보
조시온 ( Jo Si-On ) - Gachon University Gil Medical Center Department of Emergency Medicine
임용수 ( Lim Yong-Su ) - Gachon University Gil Medical Center Department of Emergency Medicine
조진성 ( Cho Jin-Seong ) - Gachon University Gil Medical Center Department of Emergency Medicine
장재호 ( Jang Jae-Ho ) - Gachon University Gil Medical Center Department of Emergency Medicine
최재연 ( Choi Jea-Yeon ) - Gachon University Gil Medical Center Department of Emergency Medicine
최우성 ( Choi Woo-Sung ) - Gachon University Gil Medical Center Department of Emergency Medicine
양혁준 ( Yang Hyuk-Jun ) - Gachon University Gil Medical Center Department of Emergency Medicine

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.

키워드

Sepsis; Shock, septic; Ischemia-modified albumin; Biomarkers

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