Potential Value of Point-of-Care Testing in Improving Outpatient Sepsis

BACKGROUND
  • General practitioners are typically the first health care provider assessing patients with acute infections.
  • This applies to sepsis cases as well
  • Most sepsis cases begin outside the hospital:
    • 75% of all sepsis patients admitted to the hospital were at home 4 days prior to hospital admission.
    • 25% of patients with sepsis admitted to the hospital had a medical encounter within 7 days prior to hospitalization (Fay et al; JAMA 2020)
  • Finding these patients in an outpatient environment would aid in early sepsis identification and intervention.
  • Point-of-care testing (POCT) in primary care had experienced increased use due to its:
    • Quick results (10-20 minutes)
    • Bedside availability
    • Ease of use (finger prick)
  • Assessment of POCT sepsis biomarkers in sepsis suspected adults in the primary care setting may aid in early identification and improved outcomes.
REVIEW
  • A recent evaluation of POCT of several sepsis biomarkers was published in patients with suspected infection in “out of hours” General Practitioner cooperative centers within the Netherlands.
  • June 2018 to March 2020
  • Investigators were blinded to patient outcome when assessing the impact of POCT results.
  • Primary Outcome was predictive value of sepsis identification within 72 hours of evaluation using Sepsis-3 definitions
  • Secondary outcomes were ICU admission within 72 hours, 30 day mortality or positive blood cultures.

RESULTS

  • 336 patients: 141 Sepsis; 195 Without Sepsis
  • The predictive value of the POCT Biomarkers was consistently poor.
  • Biomarkers within the POCT could not markedly improve the predictability of sepsis in an outpatient population.

CONCLUSION

  • POCT has increased in use over the past few years.
  • None of the biomarkers tested added clinically relevant diagnostic information.
  • Routine use of point of care testing of sepsis biomarkers in a general outpatient population cannot be recommended at the current time.

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Erkan Hassan is the Co-Founder & Chief Clinical Officer of Sepsis Program Optimization where he designs & oversees the implementation of solutions to optimize sepsis programs.

To discuss your organization’s Barriers of Effective Sepsis Care, contact Erkan by phone (844) 4SEPSIS (844-473-7747), email (erkan@spo.icu), or video chat.