Horst, S. ter (Sanne) (2020) Photoplethysmography as a new prognostic method for sepsis patients at the emergency department. thesis, Medicine.
Full text available on request.Abstract
Rationale: Early recognition of sepsis is important to prevent deterioration of the patient. Currently, scoring systems help identifying sepsis patients at the emergency department (ED) i.e. qSOFA (quick Sequential Organ Failure Assessment). However, these are suboptimal tools due to low sensitivity and specificity combined. Photoplethysmography (PPG) detects cardiovascular changes and might therefore allow early recognition of sepsis patients at risk for deterioration. The objective of this study is to find out which features of PPG measured in the first three hours at the ED are of prognostic value for deterioration during admission of a patient with suspected infection. Methods: This post-hoc observational study analyzed the first three hours of PPG data collected during the SepsiVit study at the ED. The primary outcome was deterioration within 72h: new onset kidney, liver and respiratory failure, Intensive Care Unit admission and in�hospital mortality. First, PPG-feature differences between the deteriorated and not�deteriorated groups were determined. Next, a logistic regression analysis was performed to establish association between PPG feature characteristics and clinical deterioration. Results: Of 55 patients, 20 (36%) deteriorated. All had new onset organ failure within 72h. The PPG-feature diastolic peak amplitude (DPA) was higher in the deteriorated group compared to the not-deteriorated group. Moreover, a higher slope of the DPA was associated with an increased likelihood of deterioration (OR 2.87; 95% CI 1.23-6.68). The area under the ROC-curve (AUROC) was 0.68 (95% CI 0.53-0.83) with a sensitivity of 35.0% and specificity of 94.3%. The qSOFA was not associated with deterioration. Conclusion: PPG as continuous waveform analysis, better predicts deterioration of a moderately ill sepsis patient than the current scoring systems, i.e. qSOFA.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Maaten, prof. J.C. ter and Bouma, dr. H.R. and Wijk, R.J. van |
| Faculty: | Medical Sciences |
| Date Deposited: | 16 Dec 2021 13:59 |
| Last Modified: | 16 Dec 2021 13:59 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2880 |
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