Prognostication of Mortality in Critically Ill Patients With Severe Infections
| Autor: | Que Yok-Ai, Guessous Idris, Dupuis-Lozeron Elise, Alves de Oliveira Clara Rodrigues, Ferreira Oliveir Carolina, Graf Rolf, Seematter Gérald, Revelly Jean-Pierre, Pagani Jean-Luc, Liaudet Lucas, Nobre Vandack, Eggimann Philippe |
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| Rok vydání: | 2015 |
| Předmět: |
Calcitonin
Male Critical Care Calcitonin Gene-Related Peptide Critical Illness macromolecular substances Biomarkers/metabolism Severity of Illness Index Switzerland/epidemiology Predictive Value of Tests Sepsis Lithostathine Brazil/epidemiology Humans Hospital Mortality Prospective Studies Protein Precursors ddc:613 musculoskeletal neural and ocular physiology C-Reactive Protein/metabolism Calcitonin/metabolism Middle Aged Protein Precursors/metabolism Prognosis Sepsis/metabolism/mortality eye diseases C-Reactive Protein nervous system Lithostathine/metabolism Female Biomarkers Brazil Switzerland |
| Zdroj: | Chest, Vol. 148, No 3 (2015) pp. 674-82 Chest |
| ISSN: | 1931-3543 0012-3692 |
| Popis: | 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.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.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.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. |
| Databáze: | OpenAIRE |
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