Hao Wang1, Zhong Li2, Mei Yin3, Xiao-Mei Chen1, Shi-Fang Ding1, Chen Li1, Qian Zhai1, Yuan Li1, Han Liu1, Da-Wei Wu4. 1. Department of Critical Care Medicine, Qilu Hospital, Shandong University, 250012, Jinan, Shandong, China. 2. Department of Orthopedics, Liaocheng People's Hospital affiliated to Taishan Medical College, 252000, Liaocheng, Shandong, China. 3. Department of Geriatrics, Qilu Hospital, Shandong University, 250012, Jinan, Shandong Province, China. 4. Department of Critical Care Medicine, Qilu Hospital, Shandong University, 250012, Jinan, Shandong, China. Electronic address: shandongicu@gmail.com.
Abstract
BACKGROUND: Given the high mortality rates in elderly patients with septic shock, the early recognition of patients at greatest risk of death is crucial for the implementation of early intervention strategies. Serum lactate and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels are often elevated in elderly patients with septic shock and are therefore important biomarkers of metabolic and cardiac dysfunction. We hypothesized that a risk stratification system that incorporates the Acute Physiology and Chronic Health Evaluation (APACHE) II score and lactate and NT-proBNP biomarkers would better predict mortality in geriatric patients with septic shock than the APACHE II score alone. METHODS: A single-center prospective study was conducted from January 2012 to December 2013 in a 30-bed intensive care unit of a triservice hospital. The lactate area score was defined as the sum of the area under the curve of serial lactate levels measured during the 24 hours following admission divided by 24. The NT-proBNP score was assigned based on NT-proBNP levels measured at admission. The combined score was calculated by adding the lactate area and NT-proBNP scores to the APACHE II score. Multivariate logistic regression analyses and receiver operating characteristic curves were used to evaluate which variables and scoring systems served as the best predictors of mortality in elderly septic patients. RESULTS: A total of 115 patients with septic shock were included in the study. The overall 28-day mortality rate was 67.0%. When compared to survivors, nonsurvivors had significantly higher lactate area scores, NT-proBNP scores, APACHE II scores, and combined scores. In the multivariate regression model, the combined score, lactate area score, and mechanical ventilation were independent risk factors associated with death. Receiver operating characteristic curves indicated that the combined score had significantly greater predictive power when compared to the APACHE II score or the NT-proBNP score (P < .05). CONCLUSIONS: A combined score that incorporates the APACHE II score with early lactate area and NT-proBNP levels is a useful method for risk stratification in geriatric patients with septic shock.
BACKGROUND: Given the high mortality rates in elderly patients with septic shock, the early recognition of patients at greatest risk of death is crucial for the implementation of early intervention strategies. Serum lactate and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels are often elevated in elderly patients with septic shock and are therefore important biomarkers of metabolic and cardiac dysfunction. We hypothesized that a risk stratification system that incorporates the Acute Physiology and Chronic Health Evaluation (APACHE) II score and lactate and NT-proBNP biomarkers would better predict mortality in geriatric patients with septic shock than the APACHE II score alone. METHODS: A single-center prospective study was conducted from January 2012 to December 2013 in a 30-bed intensive care unit of a triservice hospital. The lactate area score was defined as the sum of the area under the curve of serial lactate levels measured during the 24 hours following admission divided by 24. The NT-proBNP score was assigned based on NT-proBNP levels measured at admission. The combined score was calculated by adding the lactate area and NT-proBNP scores to the APACHE II score. Multivariate logistic regression analyses and receiver operating characteristic curves were used to evaluate which variables and scoring systems served as the best predictors of mortality in elderly septic patients. RESULTS: A total of 115 patients with septic shock were included in the study. The overall 28-day mortality rate was 67.0%. When compared to survivors, nonsurvivors had significantly higher lactate area scores, NT-proBNP scores, APACHE II scores, and combined scores. In the multivariate regression model, the combined score, lactate area score, and mechanical ventilation were independent risk factors associated with death. Receiver operating characteristic curves indicated that the combined score had significantly greater predictive power when compared to the APACHE II score or the NT-proBNP score (P < .05). CONCLUSIONS: A combined score that incorporates the APACHE II score with early lactate area and NT-proBNP levels is a useful method for risk stratification in geriatric patients with septic shock.
Authors: Saarwaani Vallabhajosyula; Zhen Wang; M Hassan Murad; Shashaank Vallabhajosyula; Pranathi R Sundaragiri; Kianoush Kashani; Wayne L Miller; Allan S Jaffe; Saraschandra Vallabhajosyula Journal: Mayo Clin Proc Innov Qual Outcomes Date: 2020-01-08
Authors: Harith Alataby; Jay Nfonoyim; Keith Diaz; Amna Al-Tkrit; Shahnaz Akhter; Sharoon David; Vishnuveni Leelaruban; Kara S Gay-Simon; Vedatta Maharaj; Bruce Colet; Cherry Hanna; Cheryl-Ann Gomez Journal: Med Sci Monit Basic Res Date: 2021-02-01