Journal article
A prospective, multicenter derivation of a biomarker panel to assess risk of organ dysfunction, shock, and death in emergency department patients with suspected sepsis
Critical care medicine, v 37(1), pp 96-104
Jan 2009
PMID: 19050610
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
To define a biomarker panel to predict organ dysfunction, shock, and in-hospital mortality in emergency department (ED) patients with suspected sepsis.
Prospective observational study.
EDs of ten academic medical centers.
There were 971 patients enrolled.
1) ED patients age > 18; 2) suspected infection or a serum lactate level > 2.5 mmol/L; and 3) two or more systemic inflammatory response syndrome criteria.
pregnancy, do-not-resuscitate status, or cardiac arrest.
Nine biomarkers were assayed from blood draws obtained on ED presentation. Multivariable logistic regression was used to identify an optimal combination of biomarkers to create a panel. The derived formula for weighting biomarker values was used to calculate a "sepsis score," which was the predicted probability of the primary outcome of severe sepsis (sepsis plus organ dysfunction) within 72 hrs. We also assessed the ability of the sepsis score to predict secondary outcome measures of septic shock within 72 hrs and in-hospital mortality. The overall rates of each outcome were severe sepsis, 52%; septic shock, 39%; and in-hospital mortality 7%. Among the nine biomarkers tested, the optimal 3-marker panel was neutrophil gelatinase-associated lipocalin, protein C, and interleukin-1 receptor antagonist. The area under the curve for the accuracy of the sepsis score derived from these three biomarkers was 0.80 for severe sepsis, 0.77 for septic shock, and 0.79 for death. When included in multivariate models with clinical variables, the sepsis score remained highly significant (p < 0.001) for all the three outcomes.
A biomarker panel of neutrophil gelatinase-associated lipocalin, interleukin-1ra, and Protein C was predictive of severe sepsis, septic shock, and death in ED patients with suspected sepsis. Further study is warranted to prospectively validate the clinical utility of these biomarkers and the sepsis score in risk-stratifying patients with suspected sepsis.
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Details
- Title
- A prospective, multicenter derivation of a biomarker panel to assess risk of organ dysfunction, shock, and death in emergency department patients with suspected sepsis
- Creators
- Nathan I Shapiro - Beth Israel Deaconess Medical CenterStephen Trzeciak - Cooper University HospitalJudd E Hollander - Beth Israel Deaconess Medical CenterRobert Birkhahn - NewYork–Presbyterian Brooklyn Methodist HospitalRonny Otero - Henry Ford Health SystemTiffany M Osborn - University of VirginiaEugene Moretti - Duke Medical CenterH Bryant Nguyen - Beth Israel Deaconess Medical CenterKyle J Gunnerson - Virginia Commonwealth UniversityDavid Milzman - Beth Israel Deaconess Medical CenterDavid F Gaieski - University of PennsylvaniaMunish Goyal - University of PennsylvaniaCharles B Cairns - Beth Israel Deaconess Medical CenterLong Ngo - Beth Israel Deaconess Medical CenterEmanuel P Rivers - Henry Ford Health System
- Publication Details
- Critical care medicine, v 37(1), pp 96-104
- Publisher
- Lippincott
- Grant note
- R01 HL091757 / NHLBI NIH HHS
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:000262269900013
- Scopus ID
- 2-s2.0-59649123701
- Other Identifier
- 991021448160104721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Critical Care Medicine