Unique sepsis study in home care for patients completed

Can we provide better diagnostic support for GPs to achieve faster and more accurate recognition of patients with sepsis (serious infection with organ failure) during home visits?

That is the question [1] posed by UMCU, Radboud University, Saltro and Star-shl together with the participating out-of-hours primary care clinics in Ede, Oss, Uden and Den Bosch. Feike Loots (urgent care physician, UMCU) is the PhD researcher on this study. The study was successfully completed despite the COVID-19 pandemic.

What are the most reliable factors for a GP to rely on in assessing these patients? And what is the value of biomarkers that are determined at the point of care (POCT)? Our preliminary studies had already showed that timely recognition of sepsis in pre-hospital settings is often very difficult and can have negative consequences for both patient and caregiver [2-5].

357 patients with a serious infection took part in the study. They received home visits from the GP on duty from the out-of-hours primary care clinic. Three expert panels comprising intensivists, infectiologists and general practitioners assessed the cases retrospectively, based on all available medical information, to determine whether sepsis was present according to accepted criteria and opinion. Sepsis was recognised in 151 patients (42%). To the best of our knowledge, such a large GP study has never before been conducted with so many seriously ill patients.

The main article is entitled ‘Development and external validation of a clinical prediction rule for early recognition of sepsis in primary care: a diagnostic study’. The publication concludes that a new clinical prediction rule would provide the best assistance to the GP. The proposed model incorporates scores for age, body temperature, blood pressure, heart rate, oxygen saturation and mental state. Biomarkers make almost no contribution to an accurate prediction of early sepsis in patients who the GP had already assessed as suffering from an infection (main inclusion criterion of this study).

The results of this study will be published in the Netherlands and internationally in the very near future. Other articles on innovative biomarkers and cost-effectiveness will follow. These have both been submitted to an international journal.