RT info:eu-repo/semantics/article
T1 Superior accuracy of mid-regional proadrenomedullin for mortality prediction in sepsis with varying levels of illness severity
A1 Andaluz Ojeda, David
A1 Nguyen, H. Bryant
A1 Meunier-Beillard, Nicolas
A1 Cicuéndez, Ramón
A1 Quenot, Jean-Pierre
A1 Calvo, Dolores
A1 Dargent, Auguste
A1 Zarca, Esther
A1 Andrés, Cristina
A1 Nogales, Leonor
A1 Eiros Bouza, José María
A1 Tamayo Gómez, Eduardo
A1 Gandía Martínez, Francisco
A1 Bermejo Martín, Jesús Francisco
A1 Charles, Pierre Emmanuel
K1 Biomarcadores
K1 Sepsis
K1 32 Ciencias Médicas
AB Background: The use of novel sepsis biomarkers has increased in recent years. However, their prognostic valuewith 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, comparedto that of procalcitonin, C-reactive protein and lactate.Methods: This was a two-centre prospective observational cohort, enrolling severe sepsis or septic shock patientsadmitted to the ICU. Plasma biomarkers were measured during the first 12 h of admission. The association betweenbiomarkers and 28-day mortality was assessed by Cox regression analysis and Kaplan–Meier curves. Patients weredivided into three groups as evaluated by the Sequential Organ Failure Assessment (SOFA) score. The accuracy of thebiomarkers 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 mortalityrate of 31.0%. Only MR-proADM and lactate were associated with mortality in the multivariate analysis: hazardratio 8.5 versus 3.4 (p < 0.001). MR-proADM showed the best AUROC for mortality prediction at 28 days in the analysisover the entire cohort (AUROC [95% CI] 0.79 [0.74–0.84]) (p < 0.001). When patients were stratified by the degree oforgan 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). Allpatients with MR-proADM concentrations ≤0.88 nmol/L survived up to 28 days. In patients with SOFA ≤ 6, the additionof 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. MRproADMaccuracy to predict mortality is not affected by the degree of organ failure. Thus, it is a good candidate in theearly identification of sepsis patients with moderate disease severity but at risk of mortality.
PB SpringerOpen
SN 2110-5820
YR 2017
FD 2017
LK http://uvadoc.uva.es/handle/10324/44931
UL http://uvadoc.uva.es/handle/10324/44931
LA eng
NO Annals of Intensive Care, 2017, vol.7, n. 1
NO Producción Científica
DS UVaDOC
RD 18-nov-2024