Pancreatic Stone Protein in Co-Evaluation With QSOFA and News2 for Early Sepsis Detection at the Emergency Department

Early sepsis identification at the emergency department (ED) triage is essential for timely treatment and improved outcomes. This study evaluated the diagnostic performance of pancreatic stone protein (PSP) in combination with the quick Sequential Organ Failure Assessment (qSOFA) and the National Early Warning Score (NEWS2) for early sepsis detection.

As part of the PROMPT study-a noninterventional, multicenter trial across six Greek hospitals-blood samples were collected within the first hour of admission in the emergency department. PSP levels were retrospectively assessed using a nanofluidic near-patient immunoassay device (abioSCOPE, Abionic SA, Switzerland) in 362 adult patients with suspected infections and evaluated their qSOFA and NEWS2 scores. Objectives included evaluating qSOFA's performance, assessing the performance of PSP to identify high-risk patients with qSOFA ≤1, and determining the added value of combining PSP with qSOFA or NEWS2 (cutoff ≥7), using standard performance metrics.

Among 156 sepsis cases, 128 (82.1%) had qSOFA scores ≤1. A qSOFA score ≥2 demonstrated sensitivity 17.9% and specificity 97.1% for sepsis diagnosis. In comparison, a qSOFA score of 1 showed a sensitivity of 44.2% and a specificity of 63.6%, while a score of 0 yielded a sensitivity of 37.8% and a specificity of 39.3%. The addition of PSP (cutoff: 300 ng/mL) to qSOFA ≤1 improved specificity to 94.0%, with a sensitivity of 14.8%-closely mirroring the performance of qSOFA ≥2. Similarly, combining PSP with NEWS2 <7 increased true positive cases from 34 to 52, enhancing sensitivity while maintaining high specificity.

This study highlights the utility of combining PSP levels in the patient's blood with existing scoring systems to enhance early sepsis detection in high-risk ED patients. Future research will explore near-patient PSP measurements at ED triage to further refine and expedite sepsis management.