Pancreatic stone protein as an early biomarker predicting mortality in a prospective cohort of patients with sepsis requiring ICU management.

Abstract

INTRODUCTION:

Biomarkers, such as C-reactive protein [CRP] and procalcitonin [PCT], are insufficiently sensitive or specific to stratify patients with sepsis. We investigate the prognostic value of pancreatic stone protein/regenerating protein (PSP/reg) concentration in patients with severe infections.

METHODS:

PSP/reg, CRP, PCT, tumor necrosis factor-alpha (TNF-α), interleukin 1 beta (IL1-β), IL-6 and IL-8 were prospectively measured in cohort of patients ≥ 18 years of age with severe sepsis or septic shock within 24 hours of admission in a medico-surgical intensive care unit (ICU) of a community and referral university hospital, and the ability to predict in-hospital mortality was determined.

RESULTS:

We evaluated 107 patients, 33 with severe sepsis and 74 with septic shock, with in-hospital mortality rates of 6% (2/33) and 25% (17/74), respectively. Plasma concentrations of PSP/reg (343.5 vs. 73.5 ng/ml, P < 0.001), PCT (39.3 vs. 12.0 ng/ml, P < 0.001), IL-8 (682 vs. 184 ng/ml, P < 0.001) and IL-6 (1955 vs. 544 pg/ml, P < 0.01) were significantly higher in patients with septic shock than with severe sepsis. Of note, median PSP/reg was 13.0 ng/ml (IQR: 4.8) in 20 severely burned patients without infection. The area under the ROC curve for PSP/reg (0.65 [95% CI: 0.51 to 0.80]) was higher than for CRP (0.44 [0.29 to 0.60]), PCT 0.46 [0.29 to 0.61]), IL-8 (0.61 [0.43 to 0.77]) or IL-6 (0.59 [0.44 to 0.75]) in predicting in-hospital mortality. In patients with septic shock, PSP/reg was the only biomarker associated with in-hospital mortality (P = 0.049). Risk of mortality increased continuously for each ascending quartile of PSP/reg.

CONCLUSIONS:

Measurement of PSP/reg concentration within 24 hours of ICU admission may predict in-hospital mortality in patients with septic shock, identifying patients who may benefit most from tailored ICU management.

• Authors: Yok-Ai Que, Frederik Delodder, Idris Guessous, Rolf Graf, Martha Bain, Thierry Calandra, Lucas Liaudet, Philippe Eggimann
• Journal: Critical care (London, England) (Crit Care) Vol. 16 Issue 4 Pg. R114 (Jul 02 2012) ISSN: 1466-609X [Electronic] England
• PMID: 22748193 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• CALCA protein, human
• Interleukin-1beta
• Interleukin-6
• Interleukin-8
• Lithostathine
• Protein Precursors
• Tumor Necrosis Factor-alpha
• Calcitonin
• C-Reactive Protein
• Calcitonin Gene-Related Peptide

Topics

• Biomarkers (blood)
• C-Reactive Protein (metabolism)
• Calcitonin (blood)
• Calcitonin Gene-Related Peptide
• Female
• Health Status Indicators
• Hospital Mortality
• Humans
• Intensive Care Units
• Interleukin-1beta (blood)
• Interleukin-6 (blood)
• Interleukin-8 (blood)
• Lithostathine (blood)
• Male
• Middle Aged
• Pancreatitis (blood, mortality)
• Predictive Value of Tests
• Prospective Studies
• Protein Precursors (blood)
• Sepsis (blood, mortality)
• Shock, Septic (blood, mortality)
• Tumor Necrosis Factor-alpha (blood)