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Near-infrared spectroscopy to predict organ failure and outcome in sepsis

the Assessing Risk in Sepsis using a Tissue Oxygen Saturation (ARISTOS) study

Macdonald, Stephen P.J.a,b,d,e; Kinnear, Frances B.g,h; Arendts, Glenna,b,e; Ho, Kwok M.f,c; Fatovich, Daniel M.a,b,e

European Journal of Emergency Medicine: June 2019 - Volume 26 - Issue 3 - p 174–179
doi: 10.1097/MEJ.0000000000000535
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Objectives Sepsis is acute organ dysfunction in the setting of infection. An accurate diagnosis is important to guide treatment and disposition. Tissue oxygen saturation (StO2) can be estimated noninvasively by near-infrared spectroscopy (NIRS), and may be an indicator of microcirculatory dysfunction in early sepsis. We aimed to determine the utility of StO2 for sepsis recognition and outcome prediction among patients presenting to the emergency department (ED) with infection.

Patients and methods A multicentre, prospective, observational cohort study recruited patients who were being admitted to hospital with infection. StO2 was measured in the ED using a handheld NIRS device, Inspectra 300. Outcomes were sepsis, defined as an increase in sequential organ failure assessment score of at least 2 points within 72 h, and composite in-hospital mortality/ICU admission at least 3 days.

Results A cohort of 323 participants, median age 64 (interquartile range: 47–77) years, was recruited at three Australian hospitals. 143 (44%) fulfilled the criteria for sepsis and 22 (7%) died within 30 days. The mean ± SD StO2 was 74 ± 8% in sepsis and 78 ± 7% in nonsepsis (P < 0.0001). StO2 correlated with the peak sequential organ failure assessment score (Spearman’s ρ −0.27, P  <  0.0001). Area under the receiver operating characteristic curve was 0.66 (95% confidence interval: 0.60–0.72) for sepsis and 0.66 (0.58–0.75) for the composite outcome. StO2 less than 75% had an odds ratio of 2.67 (1.45–4.94; P = 0.002), for the composite outcome compared with StO2 at least 75%.

Conclusion NIRS-derived StO2 correlates with organ failure and is associated with outcome in sepsis. However, its ability to differentiate sepsis among ED patients with infection is limited. NIRS cannot be recommended for this purpose.

aCentre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research

bDivision of Emergency Medicine

cSchool of Population Health, University of Western Australia

dEmergency Department, Armadale Health Service

eEmergency Department

fDepartment of Intensive Care, Royal Perth Hospital, Perth, Western Australia

gEmergency Department, The Prince Charles Hospital, Chermside

hSchool of Medicine, University of Queensland, Brisbane, Queensland, Australia

Received 12 July 2017 Accepted 30 October 2017

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website, www.euro-emergencymed.com.

Correspondence to Stephen P.J. Macdonald, BSc, MBChB, FRCP, FACEM, Emergency Department, Royal Perth Hospital, PO Box 2213, Perth, WA 6000, Australia Tel: +61 8 9224 8458; fax: +61 8 9224 1494; e-mail: stephen.macdonald@uwa.edu.au

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