Derivation of a multi-biomarker model and score as a predictor of 30-day mortality in critically ill sepsis patients: A prospective cohort study

OBJECTIVE The objective of this study was to assess five biomarkers in sepsis: procalcitonin (PCT), interleukin-6 (IL-6), paraoxonase (PON) and arylesterase (ARE) activities of PON-1 and white blood cell (WBC) count in order to derive a multi-biomarker risk stratification model and score to predict...

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Main Authors:	Wan Shukeri, Wan Fadzlina, Md Ralib, Azrina, Abdullah, Zamzila, Mat Nor, Mohd. Basri
Format:	Conference or Workshop Item
Language:	English
Published:	2017
Subjects:	R Medicine (General)
Online Access:	http://irep.iium.edu.my/56697/ http://irep.iium.edu.my/56697/ http://irep.iium.edu.my/56697/13/56697.pdf

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spelling	iium-566972017-05-12T01:35:13Z http://irep.iium.edu.my/56697/ Derivation of a multi-biomarker model and score as a predictor of 30-day mortality in critically ill sepsis patients: A prospective cohort study Wan Shukeri, Wan Fadzlina Md Ralib, Azrina Abdullah, Zamzila Mat Nor, Mohd. Basri R Medicine (General) OBJECTIVE The objective of this study was to assess five biomarkers in sepsis: procalcitonin (PCT), interleukin-6 (IL-6), paraoxonase (PON) and arylesterase (ARE) activities of PON-1 and white blood cell (WBC) count in order to derive a multi-biomarker risk stratification model and score to predict 30-day mortality in critically ill patients with sepsis. METHODS This was a secondary analysis of a prospective, single-center, observational cohort performed in a 12-bed ICU in Hospital Tengku Ampuan Afzan, Pahang, Malaysia. There were 159 patients enrolled. Inclusion criteria: 1) adult patients of ≥18 years 2) presence of suspected or documented infection; and 3) a rise in SOFA score by 2 or more points. The five biomarkers were assayed within 24 hours of admission and subsequently at 24 and 48 hours later. 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 Mortality Score,” which was the predicted probability of the primary outcome of 30-day mortality. RESULTS The primary outcome of 30-day mortality was reached in 46 (28.9%) of patients. Day 1 PCT, Day 3 IL-6 and Day 3 ARE were selected in the final step of the regression model. The AUC for the accuracy of the Sepsis Mortality Score derived from these three biomarkers was 0.83 (95% CI 0.74-0.91, P =0.000), suggesting very good model discrimination. When included in multivariate models with clinical variables, the score remained highly significant (p < 0.001) with an OR 25.63 (95% CI 5.45-120.56). CONCLUSIONS A biomarker panel of Day 1 PCT, Day 3 IL-6 and Day 3 ARE was predictive of 30-day mortality in critically ill patients with sepsis. Further study is warranted to prospectively validate the clinical utility of these biomarkers and the Sepsis Mortality Score in risk-stratifying patients with sepsis. 2017 Conference or Workshop Item NonPeerReviewed application/pdf en http://irep.iium.edu.my/56697/13/56697.pdf Wan Shukeri, Wan Fadzlina and Md Ralib, Azrina and Abdullah, Zamzila and Mat Nor, Mohd. Basri (2017) Derivation of a multi-biomarker model and score as a predictor of 30-day mortality in critically ill sepsis patients: A prospective cohort study. In: Malaysian Society Anaesthesiology Annual Scientific Meeting 2017, Johor Bahru, Johor. (Unpublished) http://www.msa.asm.org.my
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English
topic	R Medicine (General)
spellingShingle	R Medicine (General) Wan Shukeri, Wan Fadzlina Md Ralib, Azrina Abdullah, Zamzila Mat Nor, Mohd. Basri Derivation of a multi-biomarker model and score as a predictor of 30-day mortality in critically ill sepsis patients: A prospective cohort study
description	OBJECTIVE The objective of this study was to assess five biomarkers in sepsis: procalcitonin (PCT), interleukin-6 (IL-6), paraoxonase (PON) and arylesterase (ARE) activities of PON-1 and white blood cell (WBC) count in order to derive a multi-biomarker risk stratification model and score to predict 30-day mortality in critically ill patients with sepsis. METHODS This was a secondary analysis of a prospective, single-center, observational cohort performed in a 12-bed ICU in Hospital Tengku Ampuan Afzan, Pahang, Malaysia. There were 159 patients enrolled. Inclusion criteria: 1) adult patients of ≥18 years 2) presence of suspected or documented infection; and 3) a rise in SOFA score by 2 or more points. The five biomarkers were assayed within 24 hours of admission and subsequently at 24 and 48 hours later. 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 Mortality Score,” which was the predicted probability of the primary outcome of 30-day mortality. RESULTS The primary outcome of 30-day mortality was reached in 46 (28.9%) of patients. Day 1 PCT, Day 3 IL-6 and Day 3 ARE were selected in the final step of the regression model. The AUC for the accuracy of the Sepsis Mortality Score derived from these three biomarkers was 0.83 (95% CI 0.74-0.91, P =0.000), suggesting very good model discrimination. When included in multivariate models with clinical variables, the score remained highly significant (p < 0.001) with an OR 25.63 (95% CI 5.45-120.56). CONCLUSIONS A biomarker panel of Day 1 PCT, Day 3 IL-6 and Day 3 ARE was predictive of 30-day mortality in critically ill patients with sepsis. Further study is warranted to prospectively validate the clinical utility of these biomarkers and the Sepsis Mortality Score in risk-stratifying patients with sepsis.
format	Conference or Workshop Item
author	Wan Shukeri, Wan Fadzlina Md Ralib, Azrina Abdullah, Zamzila Mat Nor, Mohd. Basri
author_facet	Wan Shukeri, Wan Fadzlina Md Ralib, Azrina Abdullah, Zamzila Mat Nor, Mohd. Basri
author_sort	Wan Shukeri, Wan Fadzlina
title	Derivation of a multi-biomarker model and score as a predictor of 30-day mortality in critically ill sepsis patients: A prospective cohort study
title_short	Derivation of a multi-biomarker model and score as a predictor of 30-day mortality in critically ill sepsis patients: A prospective cohort study
title_full	Derivation of a multi-biomarker model and score as a predictor of 30-day mortality in critically ill sepsis patients: A prospective cohort study
title_fullStr	Derivation of a multi-biomarker model and score as a predictor of 30-day mortality in critically ill sepsis patients: A prospective cohort study
title_full_unstemmed	Derivation of a multi-biomarker model and score as a predictor of 30-day mortality in critically ill sepsis patients: A prospective cohort study
title_sort	derivation of a multi-biomarker model and score as a predictor of 30-day mortality in critically ill sepsis patients: a prospective cohort study
publishDate	2017
url	http://irep.iium.edu.my/56697/ http://irep.iium.edu.my/56697/ http://irep.iium.edu.my/56697/13/56697.pdf
first_indexed	2023-09-18T21:20:02Z
last_indexed	2023-09-18T21:20:02Z
_version_	1777411820359778304

Derivation of a multi-biomarker model and score as a predictor of 30-day mortality in critically ill sepsis patients: A prospective cohort study

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