TY - JOUR
TI - Risk assessment in sepsis: a new prognostication rule by APACHE II score and serum soluble urokinase plasminogen activator receptor
AU - Giamarellos-Bourboulis, E.J.
AU - Norrby-Teglund, A.
AU - Mylona, V.
AU - Savva, A.
AU - Tsangaris, I.
AU - Dimopoulou, I.
AU - Mouktaroudi, M.
AU - Raftogiannis, M.
AU - Georgitsi, M.
AU - Linnér, A.
AU - Adamis, G.
AU - Antonopoulou, A.
AU - Apostolidou, E.
AU - Chrisofos, M.
AU - Katsenos, C.
AU - Koutelidakis, I.
AU - Kotzampassi, K.
AU - Koratzanis, G.
AU - Koupetori, M.
AU - Kritselis, I.
AU - Lymberopoulou, K.
AU - Mandragos, K.
AU - Marioli, A.
AU - Sundén-Cullberg, J.
AU - Mega, A.
AU - Prekates, A.
AU - Routsi, C.
AU - Gogos, C.
AU - Treutiger, C.-J.
AU - Armaganidis, A.
AU - Dimopoulos, G.
JO - Critical Care and Resuscitation
PY - 2012
VL - 16
TODO - 4
SP - null
PB - 
SN - null
TODO - 10.1186/cc11463
TODO - urokinase receptor;  biological marker;  urokinase receptor, adult;  aged;  APACHE;  article;  cohort analysis;  controlled study;  double blind procedure;  enzyme linked immunosorbent assay;  female;  human;  major clinical study;  male;  mortality;  multivariate logistic regression analysis;  prediction;  priority journal;  prognosis;  prospective study;  protein blood level;  receiver operating characteristic;  risk assessment;  sepsis;  septic shock;  Sweden;  blood;  clinical trial;  epidemiology;  Greece;  intensive care unit;  Kaplan Meier method;  middle aged;  mortality;  multicenter study;  procedures;  regression analysis;  sepsis;  Shock, Septic, APACHE;  Biological Markers;  Double-Blind Method;  Female;  Greece;  Humans;  Intensive Care Units;  Kaplan-Meier Estimate;  Male;  Middle Aged;  Prospective Studies;  Receptors, Urokinase Plasminogen Activator;  Regression Analysis;  Risk Assessment;  ROC Curve;  Sepsis;  Shock, Septic;  Sweden
TODO - Introduction: Early risk assessment is the mainstay of management of patients with sepsis. APACHE II is the gold standard prognostic stratification system. A prediction rule that aimed to improve prognostication by APACHE II with the application of serum suPAR (soluble urokinase plasminogen activator receptor) is developed.Methods: A prospective study cohort enrolled 1914 patients with sepsis including 62.2% with sepsis and 37.8% with severe sepsis/septic shock. Serum suPAR was measured in samples drawn after diagnosis by an enzyme-immunoabsorbent assay; in 367 patients sequential measurements were performed. After ROC analysis and multivariate logistic regression analysis a prediction rule for risk was developed. The rule was validated in a double-blind fashion by an independent confirmation cohort of 196 sepsis patients, predominantly severe sepsis/septic shock patients, from Sweden.Results: Serum suPAR remained stable within survivors and non-survivors for 10 days. Regression analysis showed that APACHE II ≥17 and suPAR ≥12 ng/ml were independently associated with unfavorable outcome. Four strata of risk were identified: i) APACHE II <17 and suPAR <12 ng/ml with mortality 5.5%; ii) APACHE II < 17 and suPAR ≥12 ng/ml with mortality 17.4%; iii) APACHE II ≥ 17 and suPAR <12 ng/ml with mortality 37.4%; and iv) APACHE II ≥17 and suPAR ≥12 ng/ml with mortality 51.7%. This prediction rule was confirmed by the Swedish cohort.Conclusions: A novel prediction rule with four levels of risk in sepsis based on APACHE II score and serum suPAR is proposed. Prognostication by this rule is confirmed by an independent cohort. © 2012 Giamarellos-Bourboulis et al.; licensee BioMed Central Ltd.
ER -