학술논문
Biomarkers (Procalcitonin, C Reactive Protein, and Lactate) as Predictors of Mortality in Surgical Patients with Complicated Intra-Abdominal Infection.
Document Type
Academic Journal
Author
Suarez-de-la-Rica A; 1Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Madrid, Spain.; Maseda E; 1Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Madrid, Spain.; Anillo V; 1Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Madrid, Spain.; Tamayo E; 2Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario, Valladolid, Spain.; García-Bernedo CA; 3Anesthesiology and Surgical Critical Care Department, Hospital del Mar, Barcelona, Spain.; Ramasco F; 4Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Princesa, Madrid, Spain.; Hernández-Gancedo C; 1Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Madrid, Spain.; López-Tofiño A; 1Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Madrid, Spain.; Gimenez MJ; 5PRISM-AG, Madrid, Spain.; Granizo JJ; 6Preventive Medicine Department, Hospital Infanta Cristina, Parla, Madrid, Spain.; Aguilar L; 5PRISM-AG, Madrid, Spain.; Gilsanz F; 1Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Madrid, Spain.
Source
Publisher: Mary Ann Liebert, Inc Country of Publication: United States NLM ID: 9815642 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1557-8674 (Electronic) Linking ISSN: 10962964 NLM ISO Abbreviation: Surg Infect (Larchmt) Subsets: MEDLINE
Subject
Language
English
Abstract
Background: An accurate and readily available biomarker for identifying patients with complicated intra-abdominal infection needing special attention in critical care units because of their greater risk of dying would be of value for intensivists.
Methods: A multi-center, observational, retrospective study explored blood lactate, C-reactive protein (CRP), and procalcitonin (PCT) concentrations, and also Sequential Organ Failure Assessment (SOFA) and Simplified Acute Physiology Score (SAPS II) as mortality predictors in all adult patients with complicated intra-abdominal infection (cIAI) admitted to Surgical Critical Care Units (SCCUs) for ≥48 h in four Spanish hospitals (June 2012-June 2013). Logistic regression models (step-wise procedure) were constructed using as dependent variables "intra-SCCU mortality" or "overall mortality," and variables showing differences (p≤0.1) in bivariate analyses as independent variables.
Results: One hundred twenty-one cases were included. Mortality intra-SCCU (R(2)=0.189, p=0.001) was associated with SAPS II (categorized as high if ≥47) (OR=9.55; 95% CI, 1.09-83.85; p=0.042) and 24 h-lactate (≥5.87 categorized as high) (OR=6.90; 95% CI, 1.28-37.08). Overall mortality (R(2)=0.275, p=0.001) was associated with peak PCT (≥100 categorized as high) (OR=11.28; 95% CI, 1.80-70.20), peak lactate (≥1.8 categorized as high) (OR=8.86; 95% CI, 1.51-52.10) and SOFA at admission (≥7 categorized as high) (OR=8.14; 95% CI, 1.69-39.20), but was predicted better (R(2)=0.275, p=0.001) by a single dummy variable (high peak PCT-high peak lactate concentrations) (OR=99.11; 95% CI, 5.21-1885.97; p=0.002).
Conclusions: In the present study, SAPS II and 24 h-lactate concentrations predicted intra-SCCU mortality whereas overall mortality was predicted better by concurrent high PCT and lactate peak concentrations than by clinical scores or by each biomarker separately.
Methods: A multi-center, observational, retrospective study explored blood lactate, C-reactive protein (CRP), and procalcitonin (PCT) concentrations, and also Sequential Organ Failure Assessment (SOFA) and Simplified Acute Physiology Score (SAPS II) as mortality predictors in all adult patients with complicated intra-abdominal infection (cIAI) admitted to Surgical Critical Care Units (SCCUs) for ≥48 h in four Spanish hospitals (June 2012-June 2013). Logistic regression models (step-wise procedure) were constructed using as dependent variables "intra-SCCU mortality" or "overall mortality," and variables showing differences (p≤0.1) in bivariate analyses as independent variables.
Results: One hundred twenty-one cases were included. Mortality intra-SCCU (R(2)=0.189, p=0.001) was associated with SAPS II (categorized as high if ≥47) (OR=9.55; 95% CI, 1.09-83.85; p=0.042) and 24 h-lactate (≥5.87 categorized as high) (OR=6.90; 95% CI, 1.28-37.08). Overall mortality (R(2)=0.275, p=0.001) was associated with peak PCT (≥100 categorized as high) (OR=11.28; 95% CI, 1.80-70.20), peak lactate (≥1.8 categorized as high) (OR=8.86; 95% CI, 1.51-52.10) and SOFA at admission (≥7 categorized as high) (OR=8.14; 95% CI, 1.69-39.20), but was predicted better (R(2)=0.275, p=0.001) by a single dummy variable (high peak PCT-high peak lactate concentrations) (OR=99.11; 95% CI, 5.21-1885.97; p=0.002).
Conclusions: In the present study, SAPS II and 24 h-lactate concentrations predicted intra-SCCU mortality whereas overall mortality was predicted better by concurrent high PCT and lactate peak concentrations than by clinical scores or by each biomarker separately.