The following is a summary of “qSOFA combined with suPAR for early risk detection and guidance of antibiotic treatment in the emergency department: a randomized controlled trial,” published in the February 2024 issue of Critical Care by Adami et al.
Sepsis guidelines mandate immediate resuscitation for quick Sequential Organ Failure Assessment (qSOFA) 2 or 3, but the management of qSOFA 1 patients with one sign of organ dysfunction is still debated.
Researchers conducted a prospective study to assess if measuring soluble urokinase plasminogen activator receptor (suPAR) could enhance risk identification in patients with qSOFA scores 1.
They conducted a two-part study analyzing the combination of suPAR with qSOFA to detect early risk in the first part. Double-blind RCT SUPERIOR assessed the suPAR-guided medical intervention’s effectiveness in the second part. SUPERIOR occurred from November 2018 to December 2020. Multivariate stepwise Cox regression was used for the prospective cohort, and univariate and multivariate logistic regression was employed for the RCT. Consecutive admissions at the emergency department (ED) with suspected infection, qSOFA 1, and suPAR ≥ 12 ng/mL received a single infusion of placebo or meropenem. The primary endpoint was early deterioration, a one-point increase in admission SOFA score within the first 24 hours.
The results showed mortality risk with qSOFA scores of 2 and 3. The HR for 28-day mortality in patients with qSOFA = 1 and suPAR ≥ 12 ng/mL was 2.98 (95% CI 2.11-3.96) than those with qSOFA = 1 and suPAR < 12 ng/mL. The prospective RCT, with 91 patients (47 in placebo, 44 in meropenem), was halted prematurely due to pandemic-related ED re-allocations. The primary endpoint was 40.4% (n = 19) in the placebo group and 15.9% (n = 7) in the meropenem group, with a difference of 24.5% [5.9–40.8] and OR of 0.14 [0.04–0.50]. A post hoc analysis revealed significant median changes in SOFA score after 72 and 96 hours, showing 0 and − 1, respectively.
They concluded that coupling qSOFA 1 with suPAR measurements effectively improved risk prediction and potentially facilitated earlier intervention.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04825-2