Combination Biomarkers to Diagnose Sepsis in the Critically Ill Patient.
Am J Respir Crit Care Med. 2012 Apr 26;
Authors: Gibot S, Béné MC, Noel R, Massin F, Guy J, Cravoisy A, Barraud D, De Carvalho Bittencourt M, Quenot JP, Bollaert PE, Faure G, Charles PE
RationaleAlthough the outcome of sepsis benefits from the prompt administration of appropriate antibiotics upon correct diagnosis, the assessment of infection in critically ill patients is often a challenge for clinicians. In this setting, simple biomarkers, especially when used in combination, could prove useful.ObjectiveTo determine the usefulness of combination biomarkers to diagnose sepsisMethodsThree-hundred consecutive patients were enrolled to construct a biological score that was next validated in an independent prospective cohort of 79 critically ill patients from another center.Measurement and main resultsPlasma concentrations of soluble Triggering Receptor Expressed on Myeloid cells-1 (sTREM-1) and procalcitonin (PCT) were assayed, and the expression of the high affinity immunoglobulin-Fc fragment receptor I (Fc?RI) CD64 on neutrophils (PMN CD64 index) in flow cytometry was measured. A "Bioscore" combining these biomarkers was constructed. Serum concentrations of PCT and sTREM-1 as well as the PMN CD64 index were higher in septic patients compared to all others (p<0.001 for the three markers). These biomarkers were all independent predictors of infection, the best ROC curve being obtained for the PMN CD64 index. The performance of the Bioscore, better than that of each individual biomarker was externally confirmed in the validation cohort. ConclusionThis prospective study, including both inceptive and validation cohorts of unselected ICU patients demonstrates the high performance of a Bioscore combining the PMN CD64 index together with PCT and sTREM-1 serum levels in diagnosing sepsis in the critically ill patient.
PMID: 22538802 [PubMed - as supplied by publisher]