Daily Sepsis Research Analysis
Analyzed 5 papers and selected 3 impactful papers.
Summary
Today’s most informative sepsis-related studies addressed prognostic scoring in older adults, antibiotic stewardship for early-onset sepsis in extremely preterm infants, and the comparative utility of serum amyloid A versus C-reactive protein. The strongest clinically actionable signals were the limited discrimination of existing geriatric sepsis scores and the association of prelabor premature rupture of membranes and histologic chorioamnionitis with neonatal early-onset sepsis.
Research Themes
- Prognostic performance of sepsis risk scores in older adults
- Early-onset sepsis risk stratification and antibiotic stewardship in extremely preterm infants
- Biomarker assessment during sepsis and systemic inflammation
Selected Articles
1. EXPRESS: Prognostic Accuracy of SPEED, NEWS, and NEWS-L for Predicting 28-Day Mortality in Geriatric Sepsis: A Prospective Study.
This prospective single-center study evaluated 330 adults aged 65 years or older with Sepsis-3 sepsis. NEWS-L had the highest numerical area under the receiver operating characteristic curve for 28-day mortality, but all four scores showed only moderate discrimination and no pairwise differences were statistically significant.
Impact: The study provides clinically relevant negative evidence that commonly used bedside scores may be insufficient for reliable mortality stratification in geriatric sepsis. Its prospective comparison supports the need for externally validated, geriatric-specific prediction models rather than uncritical adoption of one existing score.
Clinical Implications: NEWS-L, NEWS, SPEED, and SOFA should not be interpreted as highly discriminative standalone mortality predictors in geriatric sepsis. Clinicians should integrate these scores with clinical judgment, comorbidity, functional status, frailty, and serial reassessment.
Key Findings
- Among 330 geriatric patients, 213 patients (64.5%) died within 28 days.
- NEWS-L had the highest AUC at 0.694, followed by NEWS at 0.679, SPEED at 0.653, and SOFA at 0.644.
- Pairwise DeLong comparisons found no statistically significant differences among the four scoring systems.
Methodological Strengths
- Prospective enrollment of consecutive patients meeting Sepsis-3 criteria
- Direct comparison of four clinically used prognostic scoring systems using ROC and DeLong analyses
Limitations
- The study was conducted at a single center, limiting generalizability.
- All scores demonstrated only moderate discrimination, and the sample size may have limited detection of small differences between scores.
Future Directions: Future studies should develop and externally validate geriatric-specific sepsis prediction models incorporating frailty, functional status, comorbidity burden, biomarkers, and dynamic clinical data across multiple centers.
BACKGROUND: Sepsis remains a leading cause of morbidity and mortality in older adults, and early risk stratification in the emergency department (ED) is essential for optimizing patient management. This study compared the prognostic performance of the Sequential Organ Failure Assessment (SOFA), National Early Warning Score (NEWS), National Early Warning Score-Lactate (NEWS-L), and Sepsis Prediction and Evaluation in the Emergency Department (SPEED) score for predicting 28-day mortality in geriatric patients with sepsis. METHODS: This prospective, single-center observational diagnostic accuracy study included consecutive patients aged ≥65 years who met the Sepsis-3 criteria between November 15, 2023, and November 15, 2024.
2. Impact of SAA versus CRP in evaluation of acute-phase response in familial Mediterranean fever: A prospective study.
This prospective biomarker study compared serum amyloid A (SAA) and C-reactive protein (CRP) across familial Mediterranean fever, juvenile idiopathic arthritis, acute appendicitis, sepsis, and healthy controls. In 19 serially assessed sepsis patients, SAA and CRP were positively correlated, supporting the conclusion that SAA monitoring did not improve early recognition of subclinical inflammation beyond CRP.
Impact: The study challenges the assumption that SAA necessarily provides superior monitoring of inflammatory activity in sepsis and related inflammatory disorders. Its negative comparative finding may help prevent unnecessary biomarker testing and supports continued reliance on CRP when clinically appropriate.
Clinical Implications: CRP may be sufficient for routine assessment and follow-up of acute inflammatory responses in the studied settings. SAA should not be added routinely for early detection of subclinical inflammation in sepsis without evidence of incremental clinical benefit.
Key Findings
- CRP and SAA levels were positively correlated across inflammatory and non-inflammatory phases in familial Mediterranean fever, juvenile idiopathic arthritis, and acute appendicitis.
- Among 42 patients with sepsis, mean SAA was 221.21 ± 95.05 and mean CRP was 402.2 ± 255.4.
- Serial measurements in 19 sepsis patients showed a positive correlation between SAA and CRP, and the authors concluded that SAA did not improve early recognition of subclinical inflammation.
Methodological Strengths
- Prospective assessment with measurements at defined clinical time points
- Inclusion of multiple inflammatory disease groups, sepsis patients, and healthy controls enabled comparative biomarker interpretation
Limitations
- The sepsis cohort was modest, and only 19 patients underwent serial biomarker measurements.
- The provided abstract does not report whether biomarker results changed patient management or clinical outcomes.
Future Directions: Larger multicenter studies should determine whether SAA provides incremental prognostic or treatment-guiding information over CRP using predefined clinical outcomes and cost-effectiveness analyses.
To compare the sensitivity and prognostic value of SAA and C-reactive protein (CRP) during familial Mediterranean fever (FMF) attacks and attack-free periods. Patients with juvenile idiopathic arthritis (JIA), acute appendicitis, and sepsis were used as controls. In this prospective study, 42 patients with FMF, 30 with JIA, and 30 with acute appendicitis were included. Blood samples for CRP and SAA were collected at 2 different time points: first, during an attack or preoperatively for acute appendicitis cases, and second, after the subsidence of the attack or postoperatively. To evaluate the role of SAA and CRP in the follow-up of inflammation, 42 patients with sepsis were studied serially.
3. Risk assessment of early-onset sepsis in extremely preterm infants: implications for antibiotic stewardship.
This retrospective study included 554 extremely preterm infants born at 22–29 weeks of gestation to identify risk factors for early-onset sepsis. Prelabor preterm rupture of membranes and acute chorioamnionitis on placental pathology were more frequent among infants with proven sepsis, and no infant with proven sepsis was classified as low risk.
Impact: The findings support targeted neonatal risk assessment that may help distinguish extremely preterm infants who require empiric antibiotics from those who can be monitored more selectively. This is important because antibiotic exposure in preterm infants carries risks, while missed early-onset sepsis can be fatal.
Clinical Implications: Prelabor premature rupture of membranes and placental acute chorioamnionitis should be incorporated into EOS risk assessment in extremely preterm infants. Risk-based strategies may improve antibiotic stewardship, but they should complement rather than replace close clinical observation and local neonatal protocols.
Key Findings
- The retrospective cohort included 554 infants born at 22–29 weeks of gestation.
- Prelabor preterm rupture of membranes was more common in infants with early-onset sepsis than in suspected-sepsis and control groups (P=0.02).
- Acute chorioamnionitis on placental pathology was associated with early-onset sepsis (OR 5.5, 95% CI 1.43–21; P=0.01), and no proven case was categorized as low risk.
Methodological Strengths
- The cohort was relatively large for a study of proven early-onset sepsis in extremely preterm infants.
- Comparison with suspected-sepsis and control groups allowed evaluation of risk-factor discrimination.
Limitations
- The retrospective design is susceptible to selection, information, and confounding biases.
- The provided abstract does not describe the full risk model, adjustment strategy, or external validation.
Future Directions: Prospective multicenter validation should evaluate whether obstetric and placental risk factors can safely reduce unnecessary empiric antibiotics without delaying treatment of early-onset sepsis.
OBJECTIVE: To identify risk factors for early-onset sepsis (EOS) in extremely preterm infants. STUDY DESIGN: This retrospective study included 554 infants at 22-29 RESULTS: Prelabor preterm ROM and acute chorioamnionitis on placental pathology were more common among the infants with EOS than those with suspected sepsis and controls (P = 0.02; OR 5.5, 95% CI 1.43-21, P = 0.01, respectively). None of the infants with proven EOS were classified as low risk. CONCLUSION: Risk assessment for EOS should be promoted to enhance antibiotic stewardship.