Daily Sepsis Research Analysis
Analyzed 38 papers and selected 3 impactful papers.
Summary
Analyzed 38 papers and selected 3 impactful articles.
Selected Articles
1. Prognostic value of C-reactive protein to albumin ratio (CAR) for mortality in older adults with sepsis: cohort study.
In a prospective cohort of older adults with Sepsis-3 sepsis or septic shock, CAR at baseline and 72 hours predicted 28-day mortality in sepsis and outperformed SOFA, while SOFA was superior in septic shock. An initial CAR in the highest tertile independently increased mortality risk.
Impact: Validates a low-cost, readily available biomarker that can enhance early risk stratification in older adults with sepsis, a high-risk group with constrained physiologic reserve.
Clinical Implications: Incorporate CAR into early sepsis assessments for older adults to flag high-risk patients (especially outside shock), while relying more on SOFA for septic shock. Use serial CAR (baseline and 72 h) to refine prognostication and guide escalation intensity.
Key Findings
- In sepsis (non-shock), baseline and 72-hour CAR predicted 28-day mortality with AUCs 0.867 and 0.852, outperforming SOFA (AUC 0.786).
- In septic shock, SOFA outperformed CAR (AUC 0.785 vs 0.637), indicating differential utility by severity.
- An initial CAR in the highest tertile independently predicted mortality (HR 2.88, 95% CI 1.15-5.19, p<0.001).
Methodological Strengths
- Prospective cohort design with serial biomarker measurements (baseline and 72 hours).
- Robust discrimination analyses (ROC/AUC) and multivariable time-to-event modeling (hazard ratios).
Limitations
- Single-center study in older adults; external validity across settings and ages remains to be tested.
- Abstract does not report total sample size; potential residual confounding cannot be excluded.
Future Directions: Multicenter external validation of CAR cutoffs and dynamic trajectories, integration with SOFA and lactate into composite risk tools, and interventional trials testing CAR-guided care pathways.
STUDY OBJECTIVE: To evaluate the prognostic value of the C-reactive protein/albumin (CAR) for mortality in older adults with sepsis. DESIGN AND SETTING: Prospective observational cohort study conducted at General Hospital Zone No. 21, León, Guanajuato, Mexico (Nov 2023-Aug 2025). PARTICIPANTS: Consecutive patients aged >60 years with Sepsis-3-defined sepsis or septic shock, excluding those with prior ICU care, transfers, malignancies, cirrhosis, autoimmune disease, or non-septic shock. INTERVENTIONS: None. The CAR and Sequential Organ Failure Assessment (SOFA) score were measured at diagnosis and 72hours. MAIN OUTCOME MEASURES: 28-day all-cause mortality, with predictive performance assessed via area under the ROC curve (AUC). RESULTS: CAR was higher in septic shock versus sepsis. In sepsis patients, both initial (AUC=0.867) and 72-hour (AUC=0.852) ratios predicted mortality better than SOFA (AUC=0.786). In septic shock, SOFA was superior (AUC=0.785 vs. 0.637). An initial ratio in the highest tertile independently predicted mortality (HR 2.88, 95% CI 1.15-5.19, p<0.001). CONCLUSIONS: The CAR is a strong, independent mortality predictor in older adults with sepsis, outperforming SOFA in sepsis but not in septic shock. This simple biomarker can aid early identification of high-risk patients to guide timely intervention.
2. Risk Stratification Using the Tracheostomy Early Prediction Score and the Association Between Early Tracheostomy and Mortality in Sepsis.
Using the STeP score for risk stratification in ventilated sepsis patients, early tracheostomy (≤7 days) was associated with lower in-hospital mortality only in the high-risk group, with consistent results across sensitivity analyses. No mortality benefit was observed in low- or moderate-risk groups.
Impact: Demonstrates heterogeneity of treatment effect for tracheostomy timing and provides a pragmatic framework (STeP) to target early intervention to those most likely to benefit.
Clinical Implications: Consider applying STeP risk stratification before deciding on early tracheostomy; prioritize early tracheostomy for high-risk patients while avoiding routine early procedures in low/moderate-risk groups.
Key Findings
- After propensity score matching, early tracheostomy (≤7 days) reduced in-hospital mortality in the high-risk STeP group (28.0% vs 36.1%; OR 0.67, 95% CI 0.49-0.92).
- No significant mortality difference with early vs late tracheostomy in low- or moderate-risk groups.
- Findings were robust to sensitivity analyses using mixed-effects models and inverse probability of treatment weighting.
Methodological Strengths
- Risk-stratified analysis with 1:1 propensity score matching across STeP-defined strata.
- Multiple sensitivity analyses including generalized linear mixed-effects modeling and IPTW.
Limitations
- Retrospective observational design with potential residual confounding and selection bias (only patients who underwent tracheostomy).
- Generalizability may be limited to similar health systems and practice patterns.
Future Directions: Prospective trials testing early tracheostomy targeted to STeP high-risk patients, alongside external validation of STeP thresholds and integration into ventilator liberation pathways.
BACKGROUND: The impact of tracheostomy timing on mortality in mechanically ventilated patients is inconclusive, partly because identifying patients who require a tracheostomy is challenging. This study aimed to assess the association between tracheostomy timing and mortality using risk stratification based on the Sepsis Tracheostomy Early Prediction (STeP) score. METHODS: This retrospective cohort study used data from a Japanese Intensive Care Patient Database. Subjects with sepsis who required mechanical ventilation and underwent tracheostomy were included and classified into low- (0-2), moderate- (3-6), and high-risk (≥7) groups based on the STeP score. Early (≤7 d) and late (>7 d) tracheostomy were compared within each group using 1:1 propensity score matching (PSM). Sensitivity analyses were performed using a generalized linear mixed-effects model with hospitals as a random effect to account for between-hospital variability and the inverse probability of treatment weighting. The primary outcome was the in-hospital mortality rate. RESULTS: After 1:1 PSM matching, 52, 114, and 404 matched pairs were obtained in the low-, moderate-, and high-risk groups, respectively. In the high-risk group, early tracheostomy was associated with a significantly lower mortality rate than late tracheostomy (28.0% vs 36.1%; odds ratio, 0.67, 95% CI 0.49-0.92). No significant differences were observed between low- and moderate-risk groups. These findings were consistent across sensitivity analyses. CONCLUSIONS: Early tracheostomy was associated with lower mortality in high-risk subjects as identified by the STeP score, whereas no such association was observed in low- and moderate-risk patients.
3. qREDS score compared with the REDS and NEWS2 scores to risk-stratify emergency department suspected sepsis patients for in-hospital mortality and 168-hour survival probability: a retrospective cohort study.
Removing refractory hypotension to create qREDS preserved discrimination relative to REDS and significantly outperformed NEWS2 for in-hospital mortality and 168-hour survival stratification in 3,202 ED patients with suspected sepsis. High-score thresholds (≥5) yielded high specificity for mortality.
Impact: Offers an EHR-extractable risk score that simplifies implementation while improving prognostic performance over a widely used generic early warning score.
Clinical Implications: Adopt qREDS as a pragmatic ED triage tool for suspected sepsis, using thresholds (e.g., ≥3 for heightened surveillance, ≥5 for escalation) to guide monitoring and disposition, while acknowledging need for external validation.
Key Findings
- qREDS (AUROC 0.73) matched REDS (0.74) and both outperformed NEWS2 (0.66) for in-hospital mortality (p<0.0001).
- At score ≥5, specificity for in-hospital mortality was 90.6% for qREDS versus 43.9% for NEWS2.
- Kaplan–Meier curves showed significant separation of 168-hour survival across score bands for qREDS/REDS.
Methodological Strengths
- Large single-system cohort (n=3,202) with standardized EHR data extraction and head-to-head score comparison.
- Use of ROC analysis, prespecified cut-offs, and Kaplan–Meier survival curves.
Limitations
- Retrospective, single healthcare system; external generalizability and prospective impact untested.
- Exclusion of refractory hypotension may miss hemodynamic nuance in some patients.
Future Directions: Prospective multicenter validation and EHR-embedded implementation studies to assess clinical impact, alert thresholds, and workflow integration.
BACKGROUND: The Risk-stratification of Emergency Department suspected Sepsis (REDS) score requires external validation. The six dichotomous variables and lactate can be accurately extracted electronically unlike refractory hypotension (RH), where the recording of the fluid-bolus and blood pressure measurement may be inaccurate. The impact of excluding RH is not known. OBJECTIVES: To develop the quick-REDS (qREDS) score, by removing RH from the REDS score and to validate its prognostic performance in comparison to the original score and the National Early Warning Score (NEWS)2 score, for all-cause in-hospital mortality and 168-hour survival probability (SP). METHODS: Vital signs, blood results, outcome at 168 hours and at discharge, were extracted from the electronic records of emergency department (ED) adults admitted after intravenous antibiotics for an infection. The REDS, qREDS and NEWS2 scores were calculated, receiver operating characteristic (ROC) curves constructed for in-hospital all-cause mortality, the area under the ROC (AUROC) curves compared and cut-off points noted. Test-characteristics at cut-off points ≥1, ≥3, ≥5 and ≥7 were studied. Kaplan-Meier (KM) curves were constructed for all the scores for SP at 168 hours for score bands 0-2, 3-4 and ≥5. RESULTS: Of 3202 patients, 433 died in hospital and 209 died at 168 hours. AUROC curve: REDS 0.74 (95% CI 0.72 to 0.75) and qREDS 0.73 (95% CI 0.71 to 0.75); both greater than NEWS2 0.66 (95% CI 0.65 to 0.68); p<0.0001. Cut-off points: REDS ≥3, qREDS ≥3 and NEWS2 ≥6. Specificity for in-hospital mortality of score ≥5; REDS 89.2% (95% CI 88.0% to 90.3%), qREDS 90.6% (95% CI 89.4% to 91.6%) and NEWS2 43.9% (95% CI 42.1% to 45.8%). All KM curves were significant, log-rank test p<0.0001. SP at 168 hours: whole population 93.4% (SE 0.4); SP at ≥5points: REDS 78.3% (SE 1.2), qREDS 78.0% (SE 2.0) and NEWS2 90.6% (SE 0.7). SP trends were similar at 24, 48 and 72 hours. CONCLUSION: qREDS is a valid surrogate for the REDS score and had significantly better prognostic performance than the NEWS2 score for in-hospital mortality and 168-hour survival probability, in ED patients with suspected sepsis.