Περίληψη:
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.
Συγγραφείς:
Giamarellos-Bourboulis, E.J.
Norrby-Teglund, A.
Mylona, V.
Savva, A.
Tsangaris, I.
Dimopoulou, I.
Mouktaroudi, M.
Raftogiannis, M.
Georgitsi, M.
Linnér, A.
Adamis, G.
Antonopoulou, A.
Apostolidou, E.
Chrisofos, M.
Katsenos, C.
Koutelidakis, I.
Kotzampassi, K.
Koratzanis, G.
Koupetori, M.
Kritselis, I.
Lymberopoulou, K.
Mandragos, K.
Marioli, A.
Sundén-Cullberg, J.
Mega, A.
Prekates, A.
Routsi, C.
Gogos, C.
Treutiger, C.-J.
Armaganidis, A.
Dimopoulos, G.
Λέξεις-κλειδιά:
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
