Prognostication of Mortality in Critically Ill Patients With Severe Infections.

Abstract

BACKGROUND:

The purpose of this study was to confirm the prognostic value of pancreatic stone protein (PSP) in patients with severe infections requiring ICU management and to develop and validate a model to enhance mortality prediction by combining severity scores with biomarkers.

METHODS:

We enrolled prospectively patients with severe sepsis or septic shock in mixed tertiary ICUs in Switzerland (derivation cohort) and Brazil (validation cohort). Severity scores (APACHE [Acute Physiology and Chronic Health Evaluation] II or Simplified Acute Physiology Score [SAPS] II) were combined with biomarkers obtained at the time of diagnosis of sepsis, including C-reactive-protein, procalcitonin (PCT), and PSP. Logistic regression models with the lowest prediction errors were selected to predict in-hospital mortality.

RESULTS:

Mortality rates of patients with septic shock enrolled in the derivation cohort (103 out of 158) and the validation cohort (53 out of 91) were 37% and 57%, respectively. APACHE II and PSP were significantly higher in dying patients. In the derivation cohort, the models combining either APACHE II, PCT, and PSP (area under the receiver operating characteristic curve [AUC], 0.721; 95% CI, 0.632-0.812) or SAPS II, PCT, and PSP (AUC, 0.710; 95% CI, 0.617-0.802) performed better than each individual biomarker (AUC PCT, 0.534; 95% CI, 0.433-0.636; AUC PSP, 0.665; 95% CI, 0.572-0.758) or severity score (AUC APACHE II, 0.638; 95% CI, 0.543-0.733; AUC SAPS II, 0.598; 95% CI, 0.499-0.698). These models were externally confirmed in the independent validation cohort.

CONCLUSIONS:

We confirmed the prognostic value of PSP in patients with severe sepsis and septic shock requiring ICU management. A model combining severity scores with PCT and PSP improves mortality prediction in these patients.

• Authors: Yok-Ai Que, Idris Guessous, Elise Dupuis-Lozeron, Clara Rodrigues Alves de Oliveira, Carolina Ferreira Oliveira, Rolf Graf, Gérald Seematter, Jean-Pierre Revelly, Jean-Luc Pagani, Lucas Liaudet, Vandack Nobre, Philippe Eggimann
• Journal: Chest (Chest) Vol. 148 Issue 3 Pg. 674-682 (Sep 2015) ISSN: 1931-3543 [Electronic] United States
• PMID: 26065577 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• CALCA protein, human
• Lithostathine
• Protein Precursors
• REG1A protein, human
• Calcitonin
• C-Reactive Protein
• Calcitonin Gene-Related Peptide

Topics

• Biomarkers (metabolism)
• Brazil (epidemiology)
• C-Reactive Protein (metabolism)
• Calcitonin (metabolism)
• Calcitonin Gene-Related Peptide
• Critical Care
• Critical Illness
• Female
• Hospital Mortality
• Humans
• Lithostathine (metabolism)
• Male
• Middle Aged
• Predictive Value of Tests
• Prognosis
• Prospective Studies
• Protein Precursors (metabolism)
• Sepsis (metabolism, mortality)
• Severity of Illness Index
• Switzerland (epidemiology)