Diagnostic and predictive performance of biomarkers in patients with sepsis in an intensive care unit

Khalid, Sadia; Jiang, Li

doi:10.1177/0300060518793791

Cited by 39 publications

(36 citation statements)

References 37 publications

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“…To be clinically useful, biomarkers to detect sepsis should be accurate enough to detect all the components of the SOFA. Previous works have explored the correlation between the concentration of biomarkers in plasma or serum and the total SOFA score, 5‐7 but so far, the ability of biomarkers to specifically detect each kind of organ failure considered in this score has not been studied.…”

Section: Introductionmentioning

confidence: 99%

MR‐ proADM to detect specific types of organ failure in infection

Andrés

Andaluz‐Ojeda

Cicuéndez

et al. 2020

Eur J Clin Investigation

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Background: Following the SEPSIS-3 consensus, detection of organ failure as assessed by the SOFA (Sequential Organ Failure Assessment) score, is mandatory to detect sepsis. Calculating SOFA outside of the Intensive Care Unit (ICU) is challenging. The alternative in this scenario, the quick SOFA, is very specific but less sensible. Biomarkers could help to detect the presence of organ failure secondary to infection either in ICU and non-ICU settings. Materials and methods: We evaluated the ability of four biomarkers (C-Reactive protein (CRP), lactate, mid-regional proadrenomedullin (MR-proADM) and procalcitonin (PCT)) to detect each kind of organ failure considered in the SOFA in 213 patients with infection, sepsis or septic shock, by using multivariate regression analysis and calculation of the area under the receiver operating curve (AUROC). Results: In the multivariate analysis, MR-proADM was an independent predictor of five different failures (respiratory, coagulation, cardiovascular, neurological and renal). In turn, lactate predicted three (coagulation, cardiovascular and neurological) and PCT two (cardiovascular and renal). CRP did not predict any of the individual components of SOFA. The highest AUROCs were those of MR-proADM and PCT to detect cardiovascular (AUROC, CI95%): MR-proADM (0.82 [0.76-0.88]), PCT

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Section: Introductionmentioning

confidence: 99%

MR‐ proADM to detect specific types of organ failure in infection

Andrés

Andaluz‐Ojeda

Cicuéndez

et al. 2020

Eur J Clin Investigation

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“…Установленные уровни биомаркера соответствовали диапазону значений, описанных в литературе [10,[14][15][16][17]. Первые сообщения о содержании НУП В-типа в крови больных с сепсисом появились в начале 2000-х гг.…”

Section: Discussionunclassified

“…В различных клинических ситуациях диагностически значимые уровни НУП В-типа и свойства его динамики могут существенно варьироваться в зависимости от особенностей патофизиологических процессов [5][6][7][8]. Опубликованы сообщения о диагностической и прогностической значимости увеличения содержания в крови BNP и неактивной части его предшественника (NT-proBNP) при сепсисе и септическом шоке [9][10][11]. Вместе с тем подобные исследования остаются немногочисленными.…”

Section: Introductionunclassified

N-terminal pro-B-type natriuretic peptide is a biomarker of myocardial stress in abdominal sepsis and septic shock

Tyurin¹,

Раутбарт²,

Protsenko³

et al. 2020

PKiK

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Aim. To evaluate the dynamics and prognostic significance of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) level in patients with severe abdominal sepsis.Methods. We analysed survey data of 54 patients (28 men and 26 women) aged 64.5 years [56.25–78.00] with abdominal sepsis or septic shock. Disease severity scored according to the Acute Physiology and Chronic Health Evaluation II criteria was 16.3 ± 0.8 and according to the Sequential Organ Failure Assessment (SOFA) was 3 [3–6]. Statistical analysis of these data was performed using correlation analysis, logistic regression and receiver operating characteristic analysis.Results. Serum NT-proBNP level during the 1st week following admission to the intensive care unit (ICU) exceeded normal values, i.e. 2,570 [116.25–6,559.5] to 4,600 [1,680–18,200] pg/ml. At all disease stages, serum NT-proBNP level correlated with sepsis severity scores (SOFA), procalcitonin (PCT) levels, lactatemia, mean arterial pressure, heart rate and inotropic and vasoactive–inotropic scales (rho = 0.329–0.433; p < 0.02). On ICU days 3–4, serum NT-proBNP level of >5100 pg/ml was associated with increased risk of mortality [65.6%–88.2%; area under the curve (AUC) = 0.806; р < 0.0001]. Similarly, during this interval, elevated serum NT-proBNP level was associated with the use of inotropic drugs (OR = 1.0001, 95% CI = 1.000–1.0002, p < 0.0059). Notably, we found that 76.9%–79.0% of the patients with serum NT-proBNP level of >5250 pg/ml were receiving inotropic drugs including adrenaline, dopamine and dobutamine. We were unable to identify a specific association between serum NT-proBNP level and norepinephrine administration. On ICU days 7 and 8, among patients with serum NT-proBNP level of >3450 pg/ml, we observed a very close relationship between serum NT-proBNP level and PCT (sensitivity = 63.6%, specificity = 66.7%, AUC = 0.708; р = 0.0041).Conclusion. Serum NT-proBNP level is considerably elevated in patients with abdominal sepsis or septic shock. NT-proBNP level was associated with both traditional indicators of sepsis severity and indicators characterising the state of systemic circulation. Notably, serum NT-proBNP level correlates with cardiac failure and inotropic drug requirement. Although the mechanisms underlying the observed increases in serum NT-proBNP level remain unclear, the present findings indicate that this mediator is clearly a significant biomarker and predictor of adverse outcomes related to abdominal sepsis and septic shock. Received 22 January 2020. Revised 27 January 2020. Accepted 11 February 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributions Conception and study design: I.N. Tyurin, D.N. Protsenko, I.A. Kozlov Data collection and analysis: I.N. Tyurin, S.A. Rautbart, S.N. Shurygin Statistical analysis: I.N. Tyurin, S.A. Rautbart Drafting the article: I.N. Tyurin, D.N. Protsenko, I.A. Kozlov, S.N. Shurygin Critical revision of the article: I.N. Tyurin, I.A. Kozlov Final approval of the version to be published: I.N. Tyurin, S.A. Rautbart, D.N. Protsenko, S.N. Shurygin, I.A. Kozlov

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“…The apparent disregard of CRP must be questioned; if CRP had similar diagnostic power to DcR3, then why was that not considered in combination with other biomarkers? A later study suggested that IL-6 may possibly have a role in sepsis diagnosis [70], as they noted elevated IL-6 concentrations in septic patients compared to controls. IL-6 correlated with SOFA, although it did not appear to be useful for predicting mortality.…”

Section: Adults Icumentioning

confidence: 98%

“…There is also conflicting evidence on the possible correlation of PCT with SOFA for predicting organ dysfunction. Although Mustafić and co-workers [61] concluded that PCT was a good marker of organ dysfunction, other studies have disputed this, suggesting that SOFA actually outperforms PCT for the prediction of sepsis [70]. PCT does seem to have some use in predicting patients who are eventually diagnosed with bacteraemia [71,72], which is perhaps not surprising considering the mechanism by which PCT rises in response to bacterial infection.…”

Section: Adults Intensive Care Units (Icu)mentioning

confidence: 99%

Biomarkers for Point-of-Care Diagnosis of Sepsis

2020

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Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. In 2017, almost 50 million cases of sepsis were recorded worldwide and 11 million sepsis-related deaths were reported. Therefore, sepsis is the focus of intense research to better understand the complexities of sepsis response, particularly the twin underlying concepts of an initial hyper-immune response and a counter-immunological state of immunosuppression triggered by an invading pathogen. Diagnosis of sepsis remains a significant challenge. Prompt diagnosis is essential so that treatment can be instigated as early as possible to ensure the best outcome, as delay in treatment is associated with higher mortality. In order to address this diagnostic problem, use of a panel of biomarkers has been proposed as, due to the complexity of the sepsis response, no single marker is sufficient. This review provides background on the current understanding of sepsis in terms of its epidemiology, the evolution of the definition of sepsis, pathobiology and diagnosis and management. Candidate biomarkers of interest and how current and developing point-of-care testing approaches could be used to measure such biomarkers is discussed.

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Diagnostic and predictive performance of biomarkers in patients with sepsis in an intensive care unit

Cited by 39 publications

References 37 publications

MR‐ proADM to detect specific types of organ failure in infection

MR‐ proADM to detect specific types of organ failure in infection

N-terminal pro-B-type natriuretic peptide is a biomarker of myocardial stress in abdominal sepsis and septic shock

Biomarkers for Point-of-Care Diagnosis of Sepsis

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