Work

Combined Biomarkers Discriminate Mortality Risk Among Critically Ill Patients With Suspected Sepsis

Year: 2016

Type: article

Abstract: Background. Sepsis is associated with high in-hospital and absolute mortality. Clinical diagnostic criteria for sepsis have recently been revised to improve their predictive validity for mortality. We performed dense longitudinal sampling of 9 biomarkers in a cohort of medical and surgical intensive care unit (ICU) patients with suspected sepsis to determine the utility of biomarkers as an adjunct to clinical criteria. Methods. We enrolled 139 subjects who met 2 or more systemic inflammatory response syndrome (SIRS) criteria from 2 ICUs at an academic medical center and assayed 9 biomarkers (α-2 macroglobulin, C-reactive protein, ferritin, fibrinogen, haptoglobin, procalcitonin, serum amyloid A, serum amyloid P [SAP], and tissue plasminogen activator [TPA]) at time of suspected sepsis, 24-, 48-, and 72-hours after. We compared biomarkers between groups based on both 14-day and total mortality. We also evaluated the predictive validity of individual biomarkers and biomarker pairs via area under the receiver operating characteristic curve (AUC). Results. Serum amyloid P and TPA demonstrated significant differences between groups at 7 of 8 tested timepoints for 14-day mortality and at all timepoints for total mortality (Wilcoxon p < 0.03 for all). Serum amyloid P at 48 hours had an AUC of 0.70 for both 14-day and total mortality; TPA at 72 hours had an AUC of 0.72 for 14-day and 0.67 for total mortality. Combinations of biomarkers including SAP and TPA achieved greater predictive performance, with AUC greater than 0.76 for 14-day and 0.74 for total mortality. Conclusion. Combined biomarkers discriminate critically ill subjects with suspected sepsis who are at greater risk for 14-day and total mortality. Serum amyloid P and TPA demonstrated the best discriminatory ability in this cohort. Disclosures. S. Coffin, Centers for Disease Control and Prevention: Grant Investigator, Research grant. Agency for Healthcare Research and Quality: Grant Investigator, Research grant. National Institutes of Health: Grant Investigator, Research support

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofw172.93