Prognostication of Mortality in Critically Ill Patients With Severe Infections.

Détails

ID Serval
serval:BIB_37270C5628E4
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Prognostication of Mortality in Critically Ill Patients With Severe Infections.
Périodique
Chest
Auteur(s)
Que Y.A., Guessous I., Dupuis-Lozeron E., Alves de Oliveira C.R., Ferreira Oliveir C., Graf R., Seematter G., Revelly J.P., Pagani J.L., Liaudet L., Nobre V., Eggimann P.
ISSN
1931-3543 (Electronic)
ISSN-L
0012-3692
Statut éditorial
Publié
Date de publication
2015
Peer-reviewed
Oui
Volume
148
Numéro
3
Pages
674-682
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov'tPublication Status: ppublish
Résumé
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.
Pubmed
Web of science
Création de la notice
04/12/2015 16:12
Dernière modification de la notice
03/03/2018 16:04
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