Diagnostic and prognostic value of plasma adrenomedullin compared to other biomarkers using Sepsis-3 definitions for sepsis and septic shock

Abstract Background Sepsis-3, the recent sepsis definitions, was modified based on a scoring system focused on organ failure; however, it would remain a time-consuming process to detect septic patients using these definitions. Adrenomedullin (AM) is a biomarker for diagnosing sepsis and septic shock, monitoring treatment efficacy, and prognosis. We conducted a study to assess the accuracy of AM for diagnosing and prognosing sepsis and septic shock based on the Sepsis-3 definitions.Methods This is a prospective observational single-center study. Patients admitted to the intensive care unit (ICU) were retrospectively categorized as non-sepsis, sepsis, or septic shock by Sepsis-3 definitions. Total AM (tAM) and mature AM (mAM) were measured upon ICU admission. Receiver operating characteristics (ROC) analyses were performed by calculating the area under the curve (AUC) for diagnosis and prognosis of sepsis and septic shock.ResultsA total of 98 patients were enrolled in the final analysis. Among these, 42, 22, and 34 patients were assigned to non-sepsis, sepsis, and septic shock, respectively. tAM and mAM levels significantly increased according to the severity of sepsis. The AUCs of tAM/mAM for diagnosing sepsis and septic shock were 0.879/0.848 and 0.858/0.830, respectively, whereas those of procalcitonin (PCT)/presepsin (PSEP) were 0.822/0.682 and 0.811/0.661, respectively. The AUCs of tAM/mAM on Day 1 and 3 for predicting 28-day mortality of septic patients were 0.669/0.5741 and 0.931/0.892, respectively, whereas those of sequential organ failure assessment (SOFA) score/lactate were 0.669/0.824 and 0.922/0.794, respectively.Conclusions Both tAM and mAM are reliable, early biomarkers to diagnose sepsis and septic shock according to the Sepsis-3 definitions, and are comparable to PCT. Furthermore, AM level on Day 3 is a reliable biomarker to predict 28-day mortality due to sepsis, which is comparable to that of the SOFA score and lactate level.

Download Full-text

Analisis Hubungan Sequential Organ Failure Assessment (Sofa) Score Dengan Mortalitas Pasien Sepsis

Jurnal Kesehatan Andalas ◽

10.25077/jka.v9i2.1221 ◽

2020 ◽

Vol 9 (2) ◽

pp. 168

Author(s):

Agustin Iskandar ◽

Fran Siska

Keyword(s):

Septic Shock ◽

Sequential Organ Failure Assessment ◽

Organ Failure ◽

Sofa Score ◽

Area Under The Curve ◽

International Consensus ◽

The Third ◽

Failure Assessment ◽

Sepsis And Septic Shock

Sepsis merupakan kondisi disfungsi organ mengancam nyawa yang diakibatkan oleh disregulasi sistem imun pejamu terhadap infeksi dan Sequential Organ Failure Assessment (SOFA) score merupakan suatu skoring untuk menilai kegagalan organ terkait sepsis. Peningkatan SOFA score diasosiasikan dengan outcome pasien yang lebih buruk. Tujuan: Menganalisis korelasi SOFA score dengan mortalitas pada pasien sepsis. Metode: Desain penelitian adalah kohort prospektif yang dilakukan di RSU Dr Saiful Anwar dari Maret 2018 hingga Juni 2019. Kriteria diagnosis sepsis ditegakkan berdasarkan The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Perhitungan SOFA score dilakukan dalam 2 hari pertama perawatan pasien sepsis di rumah sakit. Analisis data dilakukan pada p < 0,05. Hasil: Didapatkan 85 pasien sepsis dengan luaran meninggal sebanyak 72,94% sedangkan 28,06% membaik. Terdapat perbedaan bermakna antara SOFA score yang meninggal dan yang hidup (p=0,015). SOFA score dipakai untuk memprediksi kematian, didapatkan area under the curve (AUC) 0,74 (p=0,009), dengan cut off point optimum 7. Pada total SOFA score lebih tinggi dari sama dengan 7, didapatkan RR= 3.8, p=0.028. SOFA score merupakan parameter untuk menilai kegagalan organ pada pasien sepsis, dimana total SOFA score yang lebih tinggi dikaitkan dengan peningkatan risiko kematian. Simpulan: SOFA score pada kelompok yang meninggal lebih tinggi daripada yang sembuh. Pasien sepsis dengan SOFA score lebih besar sama dengan 7 memiliki risiko 3,8 kali lebih besar untuk meninggal.Kata kunci: risiko kematian, sepsis, SOFA score

Download Full-text

Mid-Regional Pro-Adrenomedullin (MR-proADM) as a Biomarker for Sepsis and Septic Shock: Narrative Review

Healthcare ◽

10.3390/healthcare6030110 ◽

2018 ◽

Vol 6 (3) ◽

pp. 110 ◽

Cited By ~ 7

Author(s):

Uğur Önal ◽

Francisco Valenzuela-Sánchez ◽

Kalwaje Vandana ◽

Jordi Rello

Keyword(s):

Septic Shock ◽

Randomized Controlled Trials ◽

Organ Failure ◽

Narrative Review ◽

Cochrane Library ◽

Controlled Trials ◽

Randomized Controlled ◽

Diagnosis And Prognosis ◽

Sepsis And Septic Shock

Early identification and diagnosis of sepsis and septic shock is vitally important; despite appropriate management, mortality and morbidity rates remain high. For this reason, many biomarkers and screening systems have been investigated in accordance with the precision medicine concept. A narrative review was conducted to assess the role of mid-regional pro-adrenomedullin (MR-proADM) as a biomarker for sepsis and septic shock. Relevant studies were collected via an electronic PubMed, Web of Science, and The Cochrane Library search. The review focused on both diagnosis and prognosis in patients with sepsis and septic shock and specifically in subpopulations of patients with sepsis and septic shock with burns or malignant tumors. No exclusion criteria regarding age, sex, intensive care unit admission, follow-up duration, or co morbidities were used so as to maximize sensitivity and due to lack of randomized controlled trials, opinion paper and reviews were also included in this review. A total of 22 studies, one opinion paper, and one review paper were investigated. MR-proADM levels were found to be useful in assessing patients’ initial evolution and become even more useful during follow-up with increased area under curve values in the mortality prognosis by exceeding values of 0.8 in the data shown in several studies. These results also improve along with other biomarkers or severity scores and especially correlate with the organ failure degree. The results of this study indicate that MR-proADM is a good biomarker for the diagnosis and prognosis of sepsis and septic shock patients as well as for organ failure. Although several publications have discussed its role as a biomarker for pneumonia, its value as a biomarker for sepsis and septic shock should now be assessed in randomized controlled trials and more collaborative prospective studies with larger patient samples.

Download Full-text

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

Journal of International Medical Research ◽

10.1177/0300060518793791 ◽

2018 ◽

Vol 47 (1) ◽

pp. 44-58 ◽

Cited By ~ 10

Author(s):

Yu Zhang ◽

Sadia Khalid ◽

Li Jiang

Keyword(s):

Intensive Care Unit ◽

Septic Shock ◽

Intensive Care ◽

Sofa Score ◽

Characteristic Curve ◽

Area Under The Curve ◽

Binary Logistic Regression ◽

Predictive Performance ◽

Thrombin Time ◽

Sepsis And Septic Shock

Objective This study was performed to compare the predictive performance of serum procalcitonin (PCT), N-terminal brain natriuretic propeptide (NT-proBNP), interleukin-6 (IL-6), prothrombin time (PT), thrombin time (TT), and Sequential Organ Failure Assessment (SOFA) score in the intensive care unit (ICU). Methods This retrospective cohort study enrolled 150 patients with sepsis and septic shock and 30 control patients without sepsis. Each patient was followed until death or 28 days. Correlations between variables were assessed with Spearman’s rho test. The Kruskal–Wallis and Mann–Whitney U tests were used for between-group comparisons. Results Receiver operating characteristic curve analysis of the SOFA score, PCT, NT-proBNP, IL-6, PT, and TT showed an area under the curve of 0.872, 0.732, 0.711, 0.706, 0.806, and 0.691, respectively, for diagnosing sepsis. Binary logistic regression demonstrated that the SOFA score was an independent predictor of 28-day mortality and septic shock. The correlation coefficient (r) between SOFA and PCT, NT-proBNP and SOFA, IL-6 and SOFA, PT and SOFA, and TT and SOFA was 0.79, 0.52, 0.57, 0.56, and 0.58, respectively. Conclusion While the SOFA score is the gold standard, analysis of multiple biomarkers could increase the performance capacity for diagnosis and prognosis in patients with sepsis in the ICU.

Download Full-text

SOFA Score, Hemodynamics and Body Temperature Allow Early Discrimination between Porcine Peritonitis-Induced Sepsis and Peritonitis-Induced Septic Shock

Journal of Personalized Medicine ◽

10.3390/jpm11030164 ◽

2021 ◽

Vol 11 (3) ◽

pp. 164

Author(s):

Mahmoud Al-Obeidallah ◽

Dagmar Jarkovská ◽

Lenka Valešová ◽

Jan Horák ◽

Jan Jedlička ◽

...

Keyword(s):

Septic Shock ◽

Body Temperature ◽

Sofa Score ◽

Porcine Model ◽

Venous Blood ◽

Mixed Venous Blood ◽

Mechanically Ventilated ◽

Multiple Parameters ◽

Failure Assessment ◽

Sepsis And Septic Shock

Porcine model of peritonitis-induced sepsis is a well-established clinically relevant model of human disease. Interindividual variability of the response often complicates the interpretation of findings. To better understand the biological basis of the disease variability, the progression of the disease was compared between animals with sepsis and septic shock. Peritonitis was induced by inoculation of autologous feces in fifteen anesthetized, mechanically ventilated and surgically instrumented pigs and continued for 24 h. Cardiovascular and biochemical parameters were collected at baseline (just before peritonitis induction), 12 h, 18 h and 24 h (end of the experiment) after induction of peritonitis. Analysis of multiple parameters revealed the earliest significant differences between sepsis and septic shock groups in the sequential organ failure assessment (SOFA) score, systemic vascular resistance, partial pressure of oxygen in mixed venous blood and body temperature. Other significant functional differences developed later in the course of the disease. The data indicate that SOFA score, hemodynamical parameters and body temperature discriminate early between sepsis and septic shock in a clinically relevant porcine model. Early pronounced alterations of these parameters may herald a progression of the disease toward irreversible septic shock.

Download Full-text

Early goal-directed therapy prevents organ failure and mortality in severe sepsis and septic shock

Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E. ◽

10.1007/978-88-470-2215-7_38 ◽

2003 ◽

pp. 1089-1103

Author(s):

E. Rivers ◽

B. Nguyen ◽

S. Havstad

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Organ Failure ◽

Goal Directed Therapy ◽

Early Goal Directed Therapy ◽

Sepsis And Septic Shock

Download Full-text

Diagnostic and Prognostic Value of Presepsin in Patients with Non-Infectious Organ Failure, Sepsis, and Septic Shock: A Prospective Observational Study According to the Sepsis-3 Definitions

10.21203/rs.3.rs-413686/v1 ◽

2021 ◽

Author(s):

Sukyo Lee ◽

Juhyun Song ◽

Dae Won Park ◽

Hyeri Seok ◽

Jae-hyung Cha ◽

...

Keyword(s):

Septic Shock ◽

Observational Study ◽

Organ Failure ◽

Prospective Observational Study ◽

Survival Curve ◽

Curve Analysis ◽

Roc Curve Analysis ◽

Kaplan Meier ◽

Sepsis And Septic Shock ◽

Meier Survival Curve

Abstract Background: Sepsis is life-threatening organ dysfunction due to a dysregulated host response to infection. Early diagnosis of sepsis is challenging due to unknown sources of infection, and mortality prediction is usually complex. We aimed to investigate the clinical value of presepsin for discriminating sepsis from non-infectious organ failure and predicting mortality among sepsis patients in the emergency department (ED).Methods: This prospective observational study included 420 patients divided into three groups according to the Sepsis-3 definitions: non-infectious organ failure (n=142), sepsis (n=141), and septic shock (n=137). Blood samples for biomarker measurement of presepsin, procalcitonin, and C-reactive protein were drawn in the ED and biomarker levels were compared between the groups. Optimal cut-off values for presepsin to discriminate between the three clinical diagnoses were evaluated using receiver operating characteristic (ROC) curve analysis. We also performed ROC curve analysis for each biomarker as a predictor of mortality. After excluding non-infectious organ failure, we extracted the optimal cut-off value of presepsin to predict mortality associated with sepsis and septic shock and performed Kaplan–Meier survival curve analysis according to the cut-off value.Results: Presepsin levels (median [IQR]) were significantly higher in sepsis than in non-infectious organ failure (792 [450–1273] vs. 286 [170–417], p <0.001) and significantly higher in septic shock than in sepsis (1287 [589–2365] vs. 792 [450–1273], p=0.002). The optimal cut-off value for presepsin to discriminate between sepsis and non-infectious organ failure was 582 pg/mL (sensitivity, 70.1; specificity, 89.4; AUC, 0.877; p <0.001) and to discriminate between sepsis and septic shock was 1285 pg/mL (sensitivity, 50.4; specificity, 76.6; AUC, 0.618; p <0.001). The optimal cut-off value for presepsin for predicting 30-day mortality was 821 pg/mL (sensitivity, 68.9; specificity, 50.5; AUC, 0.605; p=0.005) in patients with sepsis and septic shock. Kaplan-Meier survival curve analysis showed that patients with higher presepsin levels (≥821 pg/mL) had significantly higher mortality than patients with lower presepsin levels (<821 pg/mL) (log-rank test; p=0.004). Conclusions: Presepsin levels could effectively differentiate sepsis from non-infectious organ failure and septic shock from sepsis. Presepsin levels could help clinicians predict mortality in patients with sepsis and septic shock.

Download Full-text

Hypotension

Acute Care Casebook ◽

10.1093/med/9780190865412.003.0032 ◽

2018 ◽

pp. 163-167

Author(s):

Angela Creditt

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Organ Failure ◽

Broad Spectrum ◽

Signs And Symptoms ◽

Intravenous Fluids ◽

Key Points ◽

Life Threatening ◽

New Guidelines ◽

Sepsis And Septic Shock

Sepsis is a complex and potentially life-threatening sequela of infection that commonly occurs and can be difficult to identify. If unrecognized or undertreated, sepsis can progress to severe sepsis, septic shock, characterized by hypotension and multisystem organ failure, and ultimately death. This case illustrates classic signs and symptoms of sepsis and septic shock in a postoperative patient. Recognizing these symptoms, rapidly initiating resuscitation with intravenous fluids and broad-spectrum antibiotics and aggressive management of these patients is imperative to prevent further decompensation. In 2017, the Surviving Sepsis campaign published new guidelines to assist with the management of patients with sepsis and septic shock. Key points from these guidelines will be highlighted within this case.

Download Full-text

Biomarker combination and SOFA score for the prediction of mortality in sepsis and septic shock

Medicine ◽

10.1097/md.0000000000020495 ◽

2020 ◽

Vol 99 (22) ◽

pp. e20495 ◽

Cited By ~ 3

Author(s):

Juhyun Song ◽

Sungwoo Moon ◽

Dae Won Park ◽

Han-Jin Cho ◽

Joo Yeong Kim ◽

...

Keyword(s):

Septic Shock ◽

Sofa Score ◽

Prediction Of Mortality ◽

Sepsis And Septic Shock

Download Full-text

The Association Between Dynamic Changes in Serum Presepsin Levels and Mortality in Immunocompromised Patients with Sepsis: A Prospective Cohort Study

10.21203/rs.3.rs-115066/v1 ◽

2020 ◽

Author(s):

Jongmin Lee ◽

Seo Hyun Kim ◽

Kyung Hoon Kim ◽

Na Ri Jeong ◽

Seok Chan Kim ◽

...

Keyword(s):

Septic Shock ◽

Cohort Study ◽

Hospital Mortality ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Area Under The Curve ◽

Immunocompromised Patients ◽

Dynamic Changes ◽

Saps 3 ◽

Sepsis And Septic Shock

Abstract Background: Presepsin is a subtype of soluble CD14 that is increased in the blood of septic patients. We investigated the role of dynamic changes in serum presepsin levels in critically ill, immunocompromised patients with sepsis.Methods: This is a prospective cohort study that included 119 adult patients who were admitted to the intensive care unit (ICU) between March 2019 and June 2020. Sepsis and septic shock were defined as Sepsis-3. Patients were classified into one of the following diagnostic groups: no sepsis, sepsis, and septic shock. Presepsin level was measured on day 1 and day 3 after ICU admission. The primary outcome was in-hospital mortality.Results: Of the 119 patients, sepsis was diagnosed in 40 patients (33.6%) and septic shock was diagnosed in 60 (50.4%) patients. The Simplified Acute Physiology Score (SAPS) 3 and Sequential Organ Failure Assessment score on day 1 were 75.5 ± 14.9 and 9.0 (6.5–11.5), respectively, and the overall hospital mortality was 44.5%. In 61 immunocompromised patients, presepsin levels on day 1 were higher in patients with sepsis than those in patients without sepsis (1203.0 [773.0–2484.0] vs. 753.0 [603.5–1092.0] ng/ml; P = 0.004). The area under the curve (AUC) of presepsin for diagnosing sepsis in immunocompromised patients was 0.87, which was comparable with that of procalcitonin (AUC, 0.892). Presepsin levels on day 3 were higher in patients who died in the hospital than in those who survived (1965.0 [1149.0–3423.0] vs. 933.0 [638.0–1571.0]; P = 0.001). In immunocompromised patients who died in the hospital, presepsin levels on day 3 were significantly higher than those on day 1 (P = 0.018). In the multivariate analysis, ΔPresepsin+ (ΔPresepsin concentrations [day3 – day1] > 0) alone was independently correlated with in-hospital mortality in immunocompromised patients (odds ratio, 6.22; 95% confidence interval, 1.33–29.06; P = 0.020).Conclusion: These findings suggest that dynamic changes in presepsin levels between day 1 and day 3 are associated with in-hospital mortality in patients with sepsis, especially in immunocompromised patients.

Download Full-text