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.
ABBREVIATIONS:
APACHE ( Acute Physiology and Chronic Health Evaluation), AUC ( area under the curve), CRP ( C-reactive protein), IQR ( interquartile range), MCE ( misclassification error), PCT ( procalcitonin), PSP ( pancreatic stone protein), SAPS ( Simplified Acute Physiology Score), SOFA ( Sequential Organ Failure Assessment), SPE ( squared prediction error), suPAR ( urokinase plasminogen activator receptor)To read this article in full you will need to make a payment
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Article Info
Publication History
Accepted:
May 15,
2015
Received:
January 17,
2015
Footnotes
originally published Online First June 11, 2015.
Drs Que, Guessous, Nobre, and Eggimann contributed equally to this work.
FUNDING/SUPPORT: This study was funded by an unrestricted grant from the Loterie Romande and the Fondation pour la Recherche en Soins Intensifs and a grant from the Fundaşåo de Amparo à Pesquisa do Estado de Minas Gerais (Fapemig). Dr Que is funded by the European Commission Research [Grant FP7-Health-2013-Innovation-2-PHAGOBURN], the Swiss Initiative in System Biology (SystemsX-MicroscapesX-51RTP0-151038), the Swiss platforms for translational medicine (SwissTransMed B5-platform), and Swiss National Research Foundation [Grants SNF CRAGP3-151512 and IZ73Z0-152319]. Dr Liaudet is supported by the Swiss National Research Foundation [Grant 32000-118174/1]. Dr Guessous is supported by the Swiss National Science Foundation [Grant SNF 33CM30-124087/1].
Identification
Copyright
© 2015 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
