Isaranuwatchai, Suramath

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Isaranuwatchai, Suramath
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suramath.is@kmitl.ac.th

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    Early antibiotics administration reduces mortality in sepsis patients in tertiary care hospital
    (2025-12-01)
    Isaranuwatchai, Suramath
    ;
    Buppanharun, Jirawat
    ;
    Thongbun, Thamonwan
    ;
    Thavornwattana, Kaewklao
    ;
    Harnphadungkit, Monprach
    Introduction: Early antibiotic administration is one of the core treatments of sepsis which associated with reduced mortality rate. However, the appropriate timing of antibiotics remains a controversial issue, especially in patients without septic shock. Here, we reported the outcomes of early antibiotic administration within one hour from the time of infection suspicion in a tertiary care hospital. Methods: We reviewed the medical records and sepsis protocols in Chulabhorn Hospital, Bangkok, Thailand, from January 2021 to December 2023 for patients presenting with sepsis. We had our own sepsis protocol which we used for early detection and treatment of sepsis patients. We compared the 28-day mortality, 90-day mortality, and the length of stay between patients with time-to-antibiotics (TTA) within one hour and patients with TTA more than one hour. Results: We recruited 1,506 patients into our study. The mean age is 68 years and 49.40% of patients is female. 90.97% of the patients have comorbidities. The most common comorbidities were cancer (68.66%), and hypertension (33.40%). The 28-day mortality rate and the 90-day mortality rate were significantly lower in the patients with TTA within one hour compared to those with TTA more than one hour (P = 0.009 and P = 0.042, respectively). Nonetheless, adjusted mortality rate was significantly lower in only 28-day mortality rate but not 90-day mortality rate. Subgroup analysis showed that the mortality rate was significantly lower in patients with ICD-10 diagnosis of infections (15.35% vs. 21.51%, P = 0.029), patients with cancer (17.29% vs. 24.11%, P = 0.016), and patients with solid cancer (20.86% vs. 28.18%, P = 0.036). However, subgroup analysis for the mortality rate at 90 days were not statistically significant. Conclusion: Antibiotic administration within one hour from the time of infection suspicion is associated with lower mortality rates at 28 days but not at 90 days after adjusted analysis. Cancer patients, especially patients with solid cancer, will benefit more with time-to-antibiotics less than one hour.
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    Presepsin for sepsis diagnosis in emergency departments: a multicentre study
    (2026-06-01)
    Sri-on, Jiraporn
    ;
    Daorattanachai, Kiattichai
    ;
    Wiwatcharagoses, Kittiyaporn
    ;
    Phungoen, Pariwat
    ;
    Isaranuwatchai, Suramath
    Objectives: To evaluate the diagnostic accuracy of presepsin and procalcitonin (PCT) for sepsis and septic shock (Sepsis-3) in the emergency department (ED) based on the Sepsis-3 definition, where early diagnosis remains challenging due to the lack of rapid and reliable diagnostic methods. Methods: This multicentre prospective cohort study recruited adults from eight EDs in Thailand between October 2020 and June 2022. Patients with suspected infection or those who met the quick Sequential Organ Failure Assessment criteria were enrolled. Admission blood samples were analysed for presepsin, PCT, lactate and blood culture, with follow-up presepsin and PCT measurements performed on days 3 and 7, and follow-up for 30-day mortality. Sepsis diagnosis was adjudicated with reference to the Sepsis-3 criteria and blood culture result. Diagnostic accuracy metrics, including the area under the receiver operating characteristics curve (AUROCs), sensitivity, specificity and predictive values of presepsin and PCT were evaluated. Results: Of 668 included participants, 438 (65.6%) were diagnosed with sepsis and 58 (8.7%) with septic shock. Presepsin levels were significantly higher in patients with Sepsis-3 than in patients without sepsis at ED admission and decreased over time. Presepsin exhibited a slightly higher AUROC for predicting sepsis (AUROC 0.63 (95% CI 0.59 to 0.67)) and septic shock (AUROC 0.73 (95% CI 0.66 to 0.80)) compared with PCT (AUROC for sepsis 0.62, 95% CI 0.58 to 0.66 and septic shock 0.72, 95% CI 0.65 to 0.78). Elevated presepsin and PCT levels were associated with increased mortality within 30 days (OR 2.61, 95% CI 1.73 to 3.92 and OR of 1.62, 95% CI 1.09 to 2.42 consequently). Conclusions: Presepsin showed slightly higher diagnostic accuracy than PCT, but overall diagnostic accuracy was modest. When interpreted together with clinical assessment and routine tests, presepsin may assist early risk stratification and support, rather than replace, clinical judgement in decisions such as resuscitation or antibiotic initiation.