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Combined Biomarkers Predict Acute Mortality Among Critically Ill Patients with Suspected Sepsis
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Jul 2018
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Source: Crit Care Med. 46(7):1106-1113
[PDF-615.50 KB]
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Alternative Title:Crit Care Med
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Description:Objective
Sepsis is associated with high early and total in-hospital mortality. Despite recent revisions in the diagnostic criteria for sepsis that sought to improve predictive validity for mortality, it remains difficult to identify patients at greatest risk of death. We compared the utility of nine biomarkers to predict mortality in subjects with clinically suspected bacterial sepsis.
Design
Cohort study.
Setting
The medical and surgical intensive care units at an academic medical center.
Subjects
We enrolled 139 subjects who met two or more systemic inflammatory response syndrome (SIRS) criteria and received new broad-spectrum antibacterial therapy.
Interventions
We assayed nine biomarkers (α-2 macroglobulin, C-reactive protein, ferritin, fibrinogen, haptoglobin, procalcitonin, serum amyloid A, serum amyloid P [SAP], and tissue plasminogen activator [TPA]) at onset of suspected sepsis and 24-, 48-, and 72-hours thereafter. We compared biomarkers between groups based on both 14-day and total in-hospital mortality and evaluated the predictive validity of single and paired biomarkers via area under the receiver operating characteristic curve (AUROC).
Measurements and Main Results
14-day mortality was 12.9%, and total in-hospital mortality was 29.5%. SAP was significantly lower (4 of 4 timepoints) and TPA significantly higher (3 of 4 timepoints) in the 14-day mortality group, and the same pattern held for total in-hospital mortality (Wilcoxon p <= 0.046 for all timepoints). SAP and TPA demonstrated the best individual predictive performance for mortality, and combinations of biomarkers including SAP and TPA achieved greater predictive performance (AUROC greater than 0.76 for 14-day and 0.74 for total mortality).
Conclusions
Combined biomarkers predict risk for 14-day and total mortality among subjects with suspected sepsis. SAP and TPA demonstrated the best discriminatory ability in this cohort.
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Pubmed ID:29912095
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Pubmed Central ID:PMC6010038
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Volume:46
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Issue:7
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