Yok-Ai Que1, Idris Guessous2, Elise Dupuis-Lozeron3, Clara Rodrigues Alves de Oliveira4, Carolina Ferreira Oliveira4, Rolf Graf5, Gérald Seematter6, Jean-Pierre Revelly1, Jean-Luc Pagani1, Lucas Liaudet1, Vandack Nobre7, Philippe Eggimann8. 1. Department of Adult Intensive Care Medicine, University Hospital Medical Center and University of Lausanne, Lausanne, Switzerland. 2. Community Prevention Unit, University Hospital Medical Center and University of Lausanne, Lausanne, Switzerland; Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland. 3. Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland; Research Center for Statistics, University of Geneva, Geneva, Switzerland. 4. Institute of Social and Preventive Medicine, Infectious Diseases Service, University Hospital Medical Center and University of Lausanne, Lausanne, Switzerland. 5. Swiss Hepato-Pancreatico-Biliary Center, Department of Visceral and Transplant Surgery, University Hospital, Zürich, Switzerland. 6. Service d'Anesthésiologie, Hôpital Riviera, Montreux, Switzerland. 7. Graduate Program in Infectious Diseases and Tropical Medicine, Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. 8. Department of Adult Intensive Care Medicine, University Hospital Medical Center and University of Lausanne, Lausanne, Switzerland. Electronic address: Philippe.Eggimann@chuv.ch.
Abstract
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.
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.
Authors: Titus A P de Hond; Jan Jelrik Oosterheert; Susan J M van Hemert-Glaubitz; Ruben E A Musson; Karin A H Kaasjager Journal: Pathogens Date: 2022-05-09
Authors: Grégoire Stalder; Yok Ai Que; Sara Calzavarini; Laurent Burnier; Christophe Kosinski; Pierluigi Ballabeni; Thierry Roger; Thierry Calandra; Michel A Duchosal; Lucas Liaudet; Philippe Eggimann; Anne Angelillo-Scherrer Journal: PLoS One Date: 2016-10-27 Impact factor: 3.240