Prognostication of Mortality in Critically Ill Patients With Severe Infections - Que, Y. A.; Guessous, I.; Dupuis-Lozeron, E.; de Oliveira, C. R. A.; Oliveira, C. F.; Graf, R.; Seematter, G.; Revelly, J. P.; Pagani, J. L.; Liaudet, L.; Nobre, V.; Eggimann, P. (Chest, 2015)
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.
Keywords: journalArticle; *Critical Care; *Critical Illness; Biomarkers/*metabolism; Brazil/epidemiology; C-Reactive Protein/metabolism; Calcitonin Gene-Related Peptide; Calcitonin/metabolism; 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