Assessment of acute neuronal injury in critical illness: prognostication in septic shock patients - preliminary study in a Polish population.

Autor:	Pluta MP; Department of Cardiac Anaesthesia and Intensive Therapy, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland. michal.pluta@sum.edu.pl.; Department of Acute Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland. michal.pluta@sum.edu.pl.; Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland. michal.pluta@sum.edu.pl., Czempik PF; Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland., Natorska J; Department of Thromboembolic Diseases, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.; Krakow Centre for Medical Research and Technologies, John Paul II Hospital, Krakow, Poland., Krzych ŁJ; Department of Cardiac Anaesthesia and Intensive Therapy, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.; Department of Acute Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.
Jazyk:	angličtina
Zdroj:	Neurologia i neurochirurgia polska [Neurol Neurochir Pol] 2024; Vol. 58 (5), pp. 512-518. Date of Electronic Publication: 2024 Aug 05.
DOI:	10.5603/pjnns.99042
Abstrakt:	Introduction: Sepsis-associated brain dysfunction is a common organ dysfunction in sepsis. The main goal of this study was to verify whether the combined assessment of central nervous system injury markers (i.e. S100B, NSE, GFAP) and disease severity as per the Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), and Sequential Organ Failure Assessment (SOFA) classification systems, would increase the accuracy of death prediction in septic shock. Material and Methods: Markers of neuronal damage were determined in 55 patients diagnosed with septic shock with no previous neurological disease. Clinical data was collected and the scores on the APACHE II, SAPS II and SOFA prognostic scales were calculated. Death before discharge from the Intensive Care Unit (ICU) was established as the endpoint. Results: Nineteen patients (35%) died before ICU discharge. Patients who died had significantly higher S100B and NSE values, and APACHE II, SAPS II and SOFA scores (P< 0.05 for all). At the time of septic shock diagnosis, NSE levels more accurately predicted the risk of death before ICU discharge than S100B. However, NSE had no better predictive value for short-term mortality than APACHE II, SAPS II and SOFA. Adding C-reactive protein (CRP) and S100B concentrations to the APACHE II score created a predictive model with 95% mortality accuracy (AUC = 0.95; 95%CI 0.85-0.99; P = 0.03). Conclusions: The assessment of acute neuronal injury plays an important role in prognostication in patients with septic shock. The concentration of S100B protein in combination with APACHE II score and concentration of CRP more accurately predicts mortality than the APACHE II alone.
Databáze:	MEDLINE
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