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Arabi, Yaseen M.; Shirawi, Nehad; Memish, Ziad A.; Venkatesh, Srinivas; Al-Shimemeri, Abdullah

doi:10.1186/cc2373

Cited by 71 publications

(16 citation statements)

References 26 publications

(28 reference statements)

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“…Severe sepsis may result in systemic inflammation, multi-organ failure and septic shock ( 2 ). It is one of the major health concerns worldwide and also the predominant reason for intensive care unit (ICU) admission ( 3 ). There are 750,000 cases of severe sepsis diagnosed every year in the United States, accompanied by unacceptably high mortality rates ( 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of serum leptin and a promising novel diagnostic model for sepsis

Chen

Wang

et al. 2014

Experimental and Therapeutic Medicine

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Diagnosis of sepsis in critically ill patients is important to reduce morbidity and mortality. The present study was conducted to determine the role of serum leptin in the early diagnosis of sepsis and to establish a diagnostic model for sepsis. A retrospective study was conducted of 331 patients from an intensive care unit. All patients underwent consistent blood collection at 6:00 a.m. every morning after fasting. Serum leptin concentrations and additional markers of sepsis were compared between the sepsis group (n=128) and the non-sepsis group (n=203). Septic patients displayed significantly higher leptin serum concentrations compared with those of the non-sepsis group (mean concentration, 11.67 versus 4.824 mg/dl; P<0.001). The leptin levels in male patients were higher than those in female patients, particularly in the sepsis group. The accuracy of serum leptin levels in distinguishing septic patients from non-septic patients was 76%, and the area under the receiver operating characteristic (ROC) curve of serum leptin was ≤0.8. Additional markers of inflammation in the sepsis group were also significantly higher than those in the non-sepsis group. Positive correlations were identified between leptin and body temperature, heart rate and creatinine levels. Therefore, a prognostic model comprising a combination of leptin with temperature, platelet count, white blood cell count and heart rate was evaluated as an effective logistic regression model for the diagnosis of sepsis. The logistic regression output cut-off value was 0.46 and the area under the ROC curve was 0.953 (P<0.0001). It may be concluded that leptin is a valuable marker in the diagnosis of sepsis and the proposed prognostic model is an effective logistic regression model for the diagnosis of sepsis. The prognostic model is able to aid the differentiation of septic patients from non-septic patients.

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Section: Introductionmentioning

confidence: 99%

Diagnostic value of serum leptin and a promising novel diagnostic model for sepsis

Chen

Wang

et al. 2014

Experimental and Therapeutic Medicine

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“…We note that the Mortality Probability Model II at 24 hours (MPM II 24 ), customized for patients with sepsis, yielded an AUC of 0.826 in a previous study (31). MPM II 24 may perform better than our biomarker-based model, but MPM II 24 data were not recorded in the studies from which our data were pooled.…”

Section: Discussionmentioning

confidence: 81%

A Multibiomarker-Based Outcome Risk Stratification Model for Adult Septic Shock*

Wong

Lindsell

Pettilä

et al. 2014

Critical Care Medicine

109

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Objectives Clinical trials in septic shock continue to fail due, in part, to inequitable and sometimes unknown distribution of baseline mortality risk between study arms. Investigators advocate that interventional trials in septic shock require effective outcome risk stratification. We derived and tested a multibiomarker-based approach to estimate mortality risk in adults with septic shock. Design Previous genome-wide expression studies identified 12 plasma proteins as candidates for biomarker-based risk stratification. The current analysis used banked plasma samples and clinical data from existing studies. Biomarkers were assayed in plasma samples obtained from 341 subjects with septic shock within 24 hours of admission to the ICU. Classification and regression tree analysis was used to generate a decision tree predicting 28-day mortality based on a combination of both biomarkers and clinical variables. The derived tree was first tested in an independent cohort of 331 subjects, then calibrated using all subjects (n = 672), and subsequently validated in another independent cohort (n = 209). Setting Multiple ICUs in Canada, Finland, and the United States. Subjects Eight hundred eighty-one adults with septic shock or severe sepsis. Intervention None. Measurements and Main Results The derived decision tree included five candidate biomarkers, admission lactate concentration, age, and chronic disease burden. In the derivation cohort, sensitivity for mortality was 94% (95% CI, 87–97), specificity was 56% (50–63), positive predictive value was 50% (43–57), and negative predictive value was 95% (89–98). Performance was comparable in the test cohort. The calibrated decision tree had the following test characteristics in the validation cohort: sensitivity 85% (76–92), specificity 60% (51–69), positive predictive value 61% (52–70), and negative predictive value 85% (75–91). Conclusions We have derived, tested, calibrated, and validated a risk stratification tool and found that it reliably estimates the probability of mortality in adults with septic shock.

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“…First, there is as yet no ideal and widely-adopted scoring system for septic patients. Most of the scoring models, like the APACHE II score, are derived from general ICU patients and have inconsistent accuracy in predicting mortality in the sepsis population [25]. Undoubtedly, lots of efforts have been exerted to establish a sepsis-specific severity score [26,27,28]; however, none of them have gained widespread acceptance.…”

Section: Discussionmentioning

confidence: 99%

Clinical Trajectories and Causes of Death in Septic Patients with a Low APACHE II Score

Huang

Ruan

Tsai

et al. 2019

JCM

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Clinical course and mortality in septic patients with low disease severity remain poorly understood and is worth further investigation. We enrolled septic patients admitted to intensive care units (ICUs) between 2010 and 2014 with Acute Physiology and Chronic Health Evaluation II (APACHE II) scores of ≤15. We sought to determine their clinical trajectories and causes of death, and to analyze risk factors associated with in-hospital mortality. A total of 352 patients were included, of whom 89 (25%) did not survive to hospital discharge, at a rate higher than predicted (<21%) by the APACHE II score. Approximately one third (31/89) of non-survivors succumbed to index sepsis; however, more patients (34/89) died of subsequent sepsis. New-onset ICU sepsis developed in 99 (28%) patients and was an independent risk factor for mortality. In addition, septic patients with comorbid malignancy or index infection acquired in the hospital settings were more likely to have in-hospital mortality than those without. In conclusion, septic patients with low APACHE II scores were at a higher mortality risk than expected, and subsequent sepsis rather than index sepsis was the primary cause of death. This study provides insight into unexpected clinical trajectories and outcomes of septic patients with low disease severity at ICU admission and highlights the need for more research and clinical attention in this patient population.

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Cited by 71 publications

References 26 publications

Diagnostic value of serum leptin and a promising novel diagnostic model for sepsis

Diagnostic value of serum leptin and a promising novel diagnostic model for sepsis

A Multibiomarker-Based Outcome Risk Stratification Model for Adult Septic Shock*

Clinical Trajectories and Causes of Death in Septic Patients with a Low APACHE II Score

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