Point-of-Care Creatinine to Assist Clinical Decision Making in Suspected Sepsis in the Community

Abstract

Abstract Guidance published from the National Institute for Health and Care Excellence in the United Kingdom for recognition and management for sepsis in acute hospital settings dictates that patients who present with suspected sepsis who are found to have acute kidney injury are high risk and should receive urgent treatment. We aimed at evaluating point-of-care (POC) creatinine (Cr) testing for diagnosis of acute kidney injury in the context of suspected sepsis out of hospital. Correlation was calculated using Pearson correlation coefficient, and agreement using Bland-Altman plot analysis was performed between StatSensor (Nova) handheld analyzer measurement in capillary samples and concurrent serum Cr measurement measured by laboratory method using Siemens Advia 2400 Jaffe from patients presenting in the emergency department and nursing home residents. Altogether 59 paired samples from 57 patients were obtained. Mean age was 76.6 years, and 29% were females. Pearson correlation between POC and serum Cr was r = 0.812, P < 0.001. Fifty-five of 59 were within the 95% limits of agreement. Three values outside the limits of agreement were observed in mean Cr values greater than 200 μmol/L. The POC Cr was higher than serum Cr in 85% of cases with an average difference between POC Cr and serum Cr of 32.5 μmol/L. An algorithm was agreed defining high-risk patients with suspected sepsis based on doubling of baseline Cr for individuals with known or suspected baseline values of less than 200 μmol/L.