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dc.contributor.authorAndaluz Ojeda, David
dc.contributor.authorNguyen, H. Bryant
dc.contributor.authorMeunier-Beillard, Nicolas
dc.contributor.authorCicuéndez, Ramón
dc.contributor.authorQuenot, Jean-Pierre
dc.contributor.authorCalvo, Dolores
dc.contributor.authorDargent, Auguste
dc.contributor.authorZarca, Esther
dc.contributor.authorAndrés, Cristina
dc.contributor.authorNogales, Leonor
dc.contributor.authorEiros Bouza, José María 
dc.contributor.authorTamayo Gómez, Eduardo 
dc.contributor.authorGandía Martínez, Francisco
dc.contributor.authorBermejo Martín, Jesús Francisco
dc.contributor.authorCharles, Pierre Emmanuel
dc.date.accessioned2021-01-12T10:43:48Z
dc.date.available2021-01-12T10:43:48Z
dc.date.issued2017
dc.identifier.citationAnnals of Intensive Care, 2017, vol.7, n. 1es
dc.identifier.issn2110-5820es
dc.identifier.urihttp://uvadoc.uva.es/handle/10324/44931
dc.descriptionProducción Científicaes
dc.description.abstractBackground: The use of novel sepsis biomarkers has increased in recent years. However, their prognostic value with respect to illness severity has not been explored. In this work, we examined the ability of mid-regional proadrenomedullin (MR-proADM) in predicting mortality in sepsis patients with different degrees of organ failure, compared to that of procalcitonin, C-reactive protein and lactate. Methods: This was a two-centre prospective observational cohort, enrolling severe sepsis or septic shock patients admitted to the ICU. Plasma biomarkers were measured during the first 12 h of admission. The association between biomarkers and 28-day mortality was assessed by Cox regression analysis and Kaplan–Meier curves. Patients were divided into three groups as evaluated by the Sequential Organ Failure Assessment (SOFA) score. The accuracy of the biomarkers for mortality was determined by area under the receiver operating characteristic curve (AUROC) analysis. Results: A total of 326 patients with severe sepsis (21.7%) or septic shock (79.3%) were enrolled with a 28-day mortality rate of 31.0%. Only MR-proADM and lactate were associated with mortality in the multivariate analysis: hazard ratio 8.5 versus 3.4 (p < 0.001). MR-proADM showed the best AUROC for mortality prediction at 28 days in the analysis over the entire cohort (AUROC [95% CI] 0.79 [0.74–0.84]) (p < 0.001). When patients were stratified by the degree of organ failure, MR-proADM was the only biomarker to predict mortality in all severity groups (SOFA ≤ 6, SOFA = 7–12, and SOFA ≥ 13), AUROC [95% CI] of 0.75 [0.61–0.88], 0.74 [0.66–0.83] and 0.73 [0.59–0.86], respectively (p < 0.05). All patients with MR-proADM concentrations ≤0.88 nmol/L survived up to 28 days. In patients with SOFA ≤ 6, the addition of MR-proADM to the SOFA score increased the ability of SOFA to identify non-survivors, AUROC [95% CI] 0.70 [0.58–0.82] and 0.77 [0.66–0.88], respectively (p < 0.05 for both). Conclusions: The performance of prognostic biomarkers in sepsis is highly influenced by disease severity. MRproADM accuracy to predict mortality is not affected by the degree of organ failure. Thus, it is a good candidate in the early identification of sepsis patients with moderate disease severity but at risk of mortality.es
dc.format.mimetypeapplication/pdfes
dc.language.isoenges
dc.publisherSpringerOpenes
dc.rights.accessRightsinfo:eu-repo/semantics/openAccesses
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/*
dc.subject.classificationBiomarcadoreses
dc.subject.classificationSepsises
dc.titleSuperior accuracy of mid-regional proadrenomedullin for mortality prediction in sepsis with varying levels of illness severityes
dc.typeinfo:eu-repo/semantics/articlees
dc.rights.holder© SpringerOpenes
dc.identifier.doi10.1186/s13613-017-0238-9es
dc.relation.publisherversionhttps://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-017-0238-9es
dc.identifier.publicationissue1es
dc.identifier.publicationtitleAnnals of Intensive Carees
dc.identifier.publicationvolume7es
dc.peerreviewedSIes
dc.identifier.essn2110-5820es
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 Internacional*
dc.type.hasVersioninfo:eu-repo/semantics/publishedVersiones
dc.subject.unesco32 Ciencias Médicases


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