Rapid and correct identification of sepsis remains a major challenge in emergency medicine. A new study shows that the use of a clinical tool based on a specific biomarker can reduce mortality among patients with suspected sepsis without changing the time to start antibiotic treatment.
Sepsis is a severe systemic reaction of the body to an infection, which can rapidly progress to multiple organ dysfunction and death. In England, this condition is responsible for approximately 48,000 deaths annually.
The diagnosis is difficult, because the symptoms can be similar to those of non-infectious diseases, and there is currently no definitive diagnostic test. This uncertainty leads to both overdiagnosis and underdiagnosis.
Delayed treatment can have serious consequences. Antibiotics must be administered quickly in confirmed cases, but their unnecessary use contributes to the increase of antimicrobial resistance. At the same time, a wrong diagnosis can delay the identification and treatment of the real cause of the disease.
Doctors in Liverpool, together with researchers from the Center for Clinical Studies (Center for Trials Research) of Cardiff University, evaluated the effectiveness of a rapid test for the early diagnosis of sepsis.
The study, published on Sunday, in the journal The Lancet Respiratory Medicinereviewed the use of a procalcitonin-guided clinical algorithm.
Procalcitonin is a biomarker that increases in bacterial infections and can guide the decision to administer antibiotics. Although this type of tool is not currently recommended in emergencies, due to inconclusive results from previous research, the team tested its effectiveness in a large, controlled trial.
The study included 7,667 patients who presented to emergency departments with suspected sepsis.
The researchers evaluated whether integrating this rapid test into routine medical practice can improve diagnostic accuracy, reduce unnecessary antibiotic use, and maintain patient safety, as measured by overall mortality.
The results show a relative reduction in mortality of 17%, from 16.6% to 13.6%, meaning that for every 1,000 patients treated for suspected sepsis, approximately 31 lives can be saved.
The benefit was more pronounced in patients from disadvantaged communities, a relevant aspect in the context of the inequalities already documented in the evolution of sepsis.
However, the study showed that the use of the algorithm based on procalcitonin did not influence the speed of administration of intravenous antibiotics. This result contradicts the researchers’ initial hypothesis and is an important finding, as the time to initiation of treatment was one of the main objectives of the analysis.
The researchers expected that using the test would lead to faster administration of antibiotics. However, the study showed that the speed of initiation of treatment was the same, regardless of whether doctors used this tool or not, which is relevant because this aspect had been established as the main objective of the research.
The authors note that the results support the use of rapid tests for the early detection of sepsis and highlight the need to further develop biomarkers and clinical decision tools to support physicians in choosing treatment.
Sepsis remains a major cause of mortality, but there are tools that can help reduce its impact. The study provides important data for their use in practice and opens directions for future research. The integration of these methods into health systems will depend on the clarification of the mechanisms through which they produce benefits, economic evaluations and the implementation of solid models of application in practice.
The study was carried out by teams from the University of Liverpool and NHS University Hospitals of Liverpool Group, in collaboration with specialists from 20 emergency hospitals in England and Wales.