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Martin-Fernandez M, Vaquero-Roncero LM, Almansa R, Gómez-Sánchez E, Martín S, Tamayo E, Esteban-Velasco MC, Ruiz-Granado P, Aragón M, Calvo D, Rico-Feijoo J, Ortega A, Gómez-Pesquera E, Lorenzo-López M, López J, Doncel C, González-Sanchez C, Álvarez D, Zarca E, Ríos-Llorente A, Diaz-Alvarez A, Sanchez-Barrado E, Andaluz-Ojeda D, Calvo-Vecino JM, Muñoz-Bellvís L, Gomez-Herreras JI, Abad-Molina C, Bermejo-Martin JF, Aldecoa C, Heredia-Rodríguez M. Endothelial dysfunction is an early indicator of sepsis and neutrophil degranulation of septic shock in surgical patients. BJS Open 2020; 4:524-534. [PMID: 32073224 PMCID: PMC7260414 DOI: 10.1002/bjs5.50265] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/14/2020] [Indexed: 01/01/2023] Open
Abstract
Background Stratification of the severity of infection is currently based on the Sequential Organ Failure Assessment (SOFA) score, which is difficult to calculate outside the ICU. Biomarkers could help to stratify the severity of infection in surgical patients. Methods Levels of ten biomarkers indicating endothelial dysfunction, 22 indicating emergency granulopoiesis, and six denoting neutrophil degranulation were compared in three groups of patients in the first 12 h after diagnosis at three Spanish hospitals. Results There were 100 patients with infection, 95 with sepsis and 57 with septic shock. Seven biomarkers indicating endothelial dysfunction (mid‐regional proadrenomedullin (MR‐ProADM), syndecan 1, thrombomodulin, angiopoietin 2, endothelial cell‐specific molecule 1, vascular cell adhesion molecule 1 and E‐selectin) had stronger associations with sepsis than infection alone. MR‐ProADM had the highest odds ratio (OR) in multivariable analysis (OR 11·53, 95 per cent c.i. 4·15 to 32·08; P = 0·006) and the best area under the curve (AUC) for detecting sepsis (0·86, 95 per cent c.i. 0·80 to 0·91; P < 0·001). In a comparison of sepsis with septic shock, two biomarkers of neutrophil degranulation, proteinase 3 (OR 8·09, 1·34 to 48·91; P = 0·028) and lipocalin 2 (OR 6·62, 2·47 to 17·77; P = 0·002), had the strongest association with septic shock, but lipocalin 2 exhibited the highest AUC (0·81, 0·73 to 0·90; P < 0·001). Conclusion MR‐ProADM and lipocalin 2 could be alternatives to the SOFA score in the detection of sepsis and septic shock respectively in surgical patients with infection.
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Affiliation(s)
- M Martin-Fernandez
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.,Research Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - L M Vaquero-Roncero
- Anaesthesiology and Reanimation Service, Hospital Universitario de Salamanca, Salamanca, Spain
| | - R Almansa
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.,Research Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Biomedical Research Networking Centre on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - E Gómez-Sánchez
- Group for Biomedical Research in Critical Care (BioCritic), Anaesthesiology and Reanimation Service, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - S Martín
- Anaesthesiology and Reanimation Service, Hospital Universitario Río Hortega, Valladolid, Spain
| | - E Tamayo
- Group for Biomedical Research in Critical Care (BioCritic), Anaesthesiology and Reanimation Service, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - M C Esteban-Velasco
- Department of General and Gastrointestinal Surgery, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL) and Universidad de Salamanca, Salamanca, Spain
| | - P Ruiz-Granado
- Group for Biomedical Research in Critical Care (BioCritic), Anaesthesiology and Reanimation Service, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - M Aragón
- Group for Biomedical Research in Critical Care (BioCritic), Anaesthesiology and Reanimation Service, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - D Calvo
- Clinical Analysis Service, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - J Rico-Feijoo
- Anaesthesiology and Reanimation Service, Hospital Universitario Río Hortega, Valladolid, Spain
| | - A Ortega
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.,Research Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - E Gómez-Pesquera
- Group for Biomedical Research in Critical Care (BioCritic), Anaesthesiology and Reanimation Service, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - M Lorenzo-López
- Group for Biomedical Research in Critical Care (BioCritic), Anaesthesiology and Reanimation Service, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - J López
- Department of General and Gastrointestinal Surgery, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL) and Universidad de Salamanca, Salamanca, Spain
| | - C Doncel
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.,Research Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - C González-Sanchez
- Department of General and Gastrointestinal Surgery, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL) and Universidad de Salamanca, Salamanca, Spain
| | - D Álvarez
- Anaesthesiology and Reanimation Service, Hospital Universitario de Salamanca, Salamanca, Spain
| | - E Zarca
- Clinical Analysis Service, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - A Ríos-Llorente
- Anaesthesiology and Reanimation Service, Hospital Universitario de Salamanca, Salamanca, Spain
| | - A Diaz-Alvarez
- Anaesthesiology and Reanimation Service, Hospital Universitario de Salamanca, Salamanca, Spain
| | - E Sanchez-Barrado
- Anaesthesiology and Reanimation Service, Hospital Universitario de Salamanca, Salamanca, Spain
| | - D Andaluz-Ojeda
- Intensive Care Medicine Service, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - J M Calvo-Vecino
- Anaesthesiology and Reanimation Service, Hospital Universitario de Salamanca, Salamanca, Spain
| | - L Muñoz-Bellvís
- Department of General and Gastrointestinal Surgery, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL) and Universidad de Salamanca, Salamanca, Spain.,Biomedical Research Networking Centre on Cancer (CIBERONC), Madrid, Spain
| | - J I Gomez-Herreras
- Group for Biomedical Research in Critical Care (BioCritic), Anaesthesiology and Reanimation Service, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - C Abad-Molina
- Microbiology and Immunology Service, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - J F Bermejo-Martin
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.,Research Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Biomedical Research Networking Centre on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - C Aldecoa
- Anaesthesiology and Reanimation Service, Hospital Universitario Río Hortega, Valladolid, Spain
| | - M Heredia-Rodríguez
- Anaesthesiology and Reanimation Service, Hospital Universitario de Salamanca, Salamanca, Spain
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Andaluz-Ojeda D, Nguyen HB, Meunier-Beillard N, Cicuéndez R, Quenot JP, Calvo D, Dargent A, Zarca E, Andrés C, Nogales L, Eiros JM, Tamayo E, Gandía F, Bermejo-Martín JF, Charles PE. Superior accuracy of mid-regional proadrenomedullin for mortality prediction in sepsis with varying levels of illness severity. Ann Intensive Care 2017; 7:15. [PMID: 28185230 PMCID: PMC5307393 DOI: 10.1186/s13613-017-0238-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/27/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The use of novel sepsis biomarkers has increased in recent years. However, their prognostic value with respect to illness severity has not been explored. In this work, we examined the ability of mid-regional proadrenomedullin (MR-proADM) in predicting mortality in sepsis patients with different degrees of organ failure, compared to that of procalcitonin, C-reactive protein and lactate. METHODS This was a two-centre prospective observational cohort, enrolling severe sepsis or septic shock patients admitted to the ICU. Plasma biomarkers were measured during the first 12 h of admission. The association between biomarkers and 28-day mortality was assessed by Cox regression analysis and Kaplan-Meier curves. Patients were divided into three groups as evaluated by the Sequential Organ Failure Assessment (SOFA) score. The accuracy of the biomarkers for mortality was determined by area under the receiver operating characteristic curve (AUROC) analysis. RESULTS A total of 326 patients with severe sepsis (21.7%) or septic shock (79.3%) were enrolled with a 28-day mortality rate of 31.0%. Only MR-proADM and lactate were associated with mortality in the multivariate analysis: hazard ratio 8.5 versus 3.4 (p < 0.001). MR-proADM showed the best AUROC for mortality prediction at 28 days in the analysis over the entire cohort (AUROC [95% CI] 0.79 [0.74-0.84]) (p < 0.001). When patients were stratified by the degree of organ failure, MR-proADM was the only biomarker to predict mortality in all severity groups (SOFA ≤ 6, SOFA = 7-12, and SOFA ≥ 13), AUROC [95% CI] of 0.75 [0.61-0.88], 0.74 [0.66-0.83] and 0.73 [0.59-0.86], respectively (p < 0.05). All patients with MR-proADM concentrations ≤0.88 nmol/L survived up to 28 days. In patients with SOFA ≤ 6, the addition of MR-proADM to the SOFA score increased the ability of SOFA to identify non-survivors, AUROC [95% CI] 0.70 [0.58-0.82] and 0.77 [0.66-0.88], respectively (p < 0.05 for both). CONCLUSIONS The performance of prognostic biomarkers in sepsis is highly influenced by disease severity. MR-proADM accuracy to predict mortality is not affected by the degree of organ failure. Thus, it is a good candidate in the early identification of sepsis patients with moderate disease severity but at risk of mortality.
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Affiliation(s)
- David Andaluz-Ojeda
- Servicio de Medicina Intensiva, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
- Group for Biomedical Research in Sepsis (Bio∙Sepsis), Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - H. Bryant Nguyen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Loma Linda University, Loma Linda, CA USA
| | - Nicolas Meunier-Beillard
- Service de Réanimation Médicale, Hôpital Bocage Central, C.H.U. DIJON, 14 rue Gaffarel, B.P. 77908-21079, Dijon Cedex, France
| | - Ramón Cicuéndez
- Servicio de Medicina Intensiva, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
- Group for Biomedical Research in Sepsis (Bio∙Sepsis), Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Jean-Pierre Quenot
- Service de Réanimation Médicale, Hôpital Bocage Central, C.H.U. DIJON, 14 rue Gaffarel, B.P. 77908-21079, Dijon Cedex, France
| | - Dolores Calvo
- Servicio de Análisis Clínicos, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Auguste Dargent
- Service de Réanimation Médicale, Hôpital Bocage Central, C.H.U. DIJON, 14 rue Gaffarel, B.P. 77908-21079, Dijon Cedex, France
| | - Esther Zarca
- Servicio de Análisis Clínicos, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Cristina Andrés
- Servicio de Análisis Clínicos, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Leonor Nogales
- Servicio de Medicina Intensiva, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
- Group for Biomedical Research in Sepsis (Bio∙Sepsis), Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Jose María Eiros
- Departmento de Microbiología, Facultad de Medicina, Universidad de Valladolid, Avda/Ramón y Cajal 7, 47005 Valladolid, Spain
| | - Eduardo Tamayo
- Group for Biomedical Research in Sepsis (Bio∙Sepsis), Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario, Avda/Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Francisco Gandía
- Servicio de Medicina Intensiva, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
- Group for Biomedical Research in Sepsis (Bio∙Sepsis), Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Jesús F. Bermejo-Martín
- Group for Biomedical Research in Sepsis (Bio∙Sepsis), Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Pierre Emmanuel Charles
- Service de Réanimation Médicale, Hôpital Bocage Central, C.H.U. DIJON, 14 rue Gaffarel, B.P. 77908-21079, Dijon Cedex, France
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