0
Original Research: Critical Care |

Prognostication of Mortality in Critically Ill Patients With Severe InfectionsBiomarker and Severity Score Predicts Fatal Sepsis

Yok-Ai Que, MD, PhD; Idris Guessous, MD, PhD; Elise Dupuis-Lozeron, MSc; Clara Rodrigues Alves de Oliveira, MD, PhD; Carolina Ferreira Oliveir, MD, PhD; Rolf Graf, PhD; Gérald Seematter, MD; Jean-Pierre Revelly, MD; Jean-Luc Pagani, MD; Lucas Liaudet, MD; Vandack Nobre, MD, PhD; Philippe Eggimann, MD
Author and Funding Information

From the Department of Adult Intensive Care Medicine (Drs Que, Revelly, Pagani, Liaudet, and Eggimann), the Community Prevention Unit (Dr Guessous), Institute of Social and Preventive Medicine, and the Infectious Diseases Service (Drs Alves de Oliveira and Ferreira Oliveira), University Hospital Medical Center and University of Lausanne, Lausanne, Switzerland; the Unit of Population Epidemiology (Dr Guessous and Ms Dupuis-Lozeron), Division of Primary Care Medicine, Department of Community Medicine, Primary Care, and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland; the Research Center for Statistics (Ms Dupuis-Lozeron), University of Geneva, Geneva, Switzerland; the Swiss Hepato-Pancreatico-Biliary Center (Dr Graf), Department of Visceral and Transplant Surgery, University Hospital, Zürich, Switzerland; the Service d’Anesthésiologie (Dr Seematter), Hôpital Riviera, Montreux, Switzerland; and the Graduate Program in Infectious Diseases and Tropical Medicine (Dr Nobre), Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.

CORRESPONDENCE TO: Philippe Eggimann, MD, BH 08-622, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011 Lausanne, Switzerland; e-mail: Philippe.Eggimann@chuv.ch


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 Fundação 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].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(3):674-682. doi:10.1378/chest.15-0123
Text Size: A A A
Published online

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.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
Early Goal-Directed Therapy in Severe Sepsis and Septic Shock Revisited*: Concepts, Controversies, and Contemporary Findings
PubMed Articles
Guidelines
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543