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Prognostication of mortality in critically ill patients with severe infections.
Chest. 2015 Jun 11;
Authors: Que YA, Guessous I, Dupuis Lozeron E, Alves de Oliveira CR, Ferreira Oliveira C, Graf R, Seematter G, Revelly JP, Pagani JL, Liaudet L, Nobre V, Eggimann P
Abstract
Background: To confirm the prognostic value of pancreatic stone protein (PSP) in patients with severe infections requiring intensive care unit (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 (Acute Physiology and Chronic Health Evaluation [APACHE II] or Simplified Acute Physiology Score [SAPS II]) were combined with biomarkers obtained at the time of diagnosis of sepsis, including C-reactive-protein (CRP), 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 (103 out of 158) cohort 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 [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; PSP:0.665, 0.572-0.758) or severity score (AUC APACHE 0.638, 0.543-0.733; SAPS II: 0.598, 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.
Trial Registration: Observational study.
PMID: 26065577 [PubMed - as supplied by publisher]