Sepsis/InfectionSepsis mortality score for the prediction of mortality in septic patients
Introduction
Sepsis remains an ongoing challenge in intensive care medicine largely because of the high mortality rate despite the provision of optimal care [1]. Initial Sequential Organ Failure Assessment (SOFA) score is one of the scoring systems used for predicting mortality in septic patients [2]. However, this approach has been criticised for its lack of capacity to discriminate outcome [3]. The use of serum biomarkers has significantly improved the clinician's ability to diagnose and predict the outcome of sepsis [4], [5].
In everyday clinical practice, the leukocytes count has been the most widely used biomarker to guide the prognosis of septic patients in addition to other clinical parameters [6]. Over the last two decades, procalcitonin (PCT) and interleukin-6 (IL-6) have emerged as biomarkers for the prediction of sepsis outcome [7], [8], [9], [10], [11], [12]. Recent studies suggested the possible role of decreased PON-1 activity in septic patients [13], [14]. PON-1 is an enzyme that is synthesised primarily in the liver, which neutralizes lipopolysaccharides and inhibits the synthesis of some pro-inflammatory cytokines. PON-1 can be evaluated according to its different activities, such as its paraoxonase (PON) activity and arylesterase (ARE) activity. Few studies have revealed the potential prognostic value of PON-1 activity in septic patients [15], [16], [17].
Because of the complex pathophysiology of sepsis, it is unlikely that a single biomarker would be able to reflect the various host responses to infection. Combining several biomarkers into a single classification rule should help to improve their accuracy and hence, their usefulness. The purpose of the present study was to derive a prediction equation using combination of leukocytes count, PCT, IL-6, and PON and ARE activities of PON-1 to predict 30-day mortality in septic patients, which we call the sepsis mortality score. We then sought to compare the performance of this prediction equation to that of the SOFA score in their ability to predict mortality in sepsis.
Section snippets
Study design and participants
This prospective observational study was performed from July 2011 to June 2014 in a 12-bed intensive care unit (ICU) in a major tertiary hospital in Pahang, Malaysia. The protocol used in this study was approved by the local medical research and ethics committee and registered under the National Medical Research Register (NMRR-13-879-15223). Written informed consent was obtained from either the patients or their legally acceptable representative prior to recruitment. Consecutive adult patients
Biomarker profiles
The medians and interquartile ranges are shown for each of the five biomarkers for the population as a whole, as well as stratified by the outcome of 30-day mortality (Table 2). As a summary measure of predictive accuracy, we determined the AUROC and the ideal cut-off values for the ability of each biomarker to classify patients with 30-day mortality (Table 2).
Development of sepsis mortality score
We used multivariate logistic regression to model the ability of biomarkers to identify patients who have the outcome of 30-day
Discussion
In this prospective study, we assembled a cohort of 159 patients with sepsis and studied five biomarkers on their ICU admission with the overall goal of creating a prediction equation, the “sepsis mortality score”, that would allow discrimination of those who are at increased risk of 30-day mortality. A sepsis mortality score using baseline leukocytes count, PCT, IL-6 and ARE activities of PON-1 predicted 30-day mortality with a very good performance (AUROC 0.814) in our sepsis cohort. Of
Conclusion
The multi-marker approach using the baseline leukocytes count, PCT, IL-6 and ARE activity of PON-1 predicted 30-day mortality with a very good performance in our sepsis cohort. Although not superior to the SOFA score, our sepsis mortality score added significant prognostic information, and is thus a valuable supplement to the SOFA score in predicting mortality in sepsis. Further studies are warranted to validate these findings and to assess whether the sepsis mortality score derived from these
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Funding
This work was supported by the International Islamic University Malaysia Endowment B Research Grant (EDWB11-256-0734).
References (25)
- et al.
Procalcitonin as a diagnostic marker and IL-6 as a prognostic marker for sepsis
Diagn Microbiol Infect Dis
(2013) - et al.
The diagnostic ability of procalcitonin and interleukin-6 to differentiate infectious from noninfectious systemic inflammatory response syndrome and to predict mortality
J Crit Care
(2016) - et al.
Interleukin 6, galectin 3, growth differentiation factor 15, and soluble ST2 for mortality prediction in critically ill patients
J Crit Care
(2016) - et al.
Early goal-directed resuscitation of patients with septic shock: current evidence and future directions
Crit Care
(2015) - et al.
The third international consensus definitions for sepsis and septic shock (Sepsis-3)
JAMA
(2016) - et al.
Limited ability of SOFA and MOD scores to discriminate outcome: a prospective evaluation in 1,436 patients
Can J Anaesth
(2005) - et al.
New approaches to sepsis: molecular diagnostics and biomarkers
Clin Microbiol Rev
(2012) - et al.
Biomarkers for sepsis: what is and what might be?
Biomark Insights
(2015) - et al.
Surviving sepsis campaign
Crit Care Med
(2013) - et al.
Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis
Am J Respir Crit Care Med
(2001)
Procalcitonin clearance for early prediction of survival in critically ill patients with severe sepsis
Crit Care Res Pract
Procalcitonin increase in early identification of critically ill patients at high risk of mortality
Crit Care Med
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