Prognostic significance of APACHE II score and plasma suPAR in Chinese patients with sepsis: a prospective observational study.

Xuan Liu,Aihua Fei,Qinmin Ge,Zhihua Li,Yong Shen,Hairong Wang,Shuming Pan

doi:10.1186/s12871-016-0212-3

Xuan Liu, Aihua Fei + Show 5 more

Open Access

https://doi.org/10.1186/s12871-016-0212-3

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Journal: BMC anesthesiology	Publication Date: Dec 1, 2015
Citations: 38	License type: cc-by

Affiliation: XinHua Hospital

Abstract

BackgroundTimely risk stratification is the key strategy to improve prognosis of patients with sepsis. Previous study has proposed to develop a powerful risk assessment rule by the combination of Acute Physiology and Chronic Health Evaluation II (APACHE II) score and plasma soluble urokinase plasminogen activator receptor (suPAR). That reaffirmation of suPAR as a prognostic marker in Chinese patients with severe sepsis is the aim of the study.MethodsA total of 137 consecutive Chinese patients with sepsis were enrolled in a prospective study cohort. Demographic and clinical characteristics, conventional risk factors and important laboratory data were prospectively recorded. Sequential plasma suPAR concentrations were measured by an enzymeimmunoabsorbent assay on days 1, 3, and 7 after admission to the intensive care unit (ICU). Receiver operating characteristic (ROC) curves and Cox regression analysis were used to examine the performance of suPAR in developing a rule for risk stratification.ResultsThe results showed that plasma suPAR concentrations remained relatively stable within survivors and non-survivors during the first week of disease course. Regression analysis indicated that APACHE II ≥15 and suPAR ≥10.82 ng/mL were independently associated with unfavorable outcome. With the above cutoffs of APACHE II and suPAR, strata of disease severity were determined. The mortality of each stratum differed significantly from the others.ConclusionsCombination of APACHE II score and suPAR may supply the powerful prognostic utility for the mortality of sepsis.

Highlights

Risk stratification is the key strategy to improve prognosis of patients with sepsis
After the initial evaluation performed in the intensive care unit (ICU), patients were divided into three groups according the disease severity: group 1, patients with sepsis (n = 56); group 2, those with severe sepsis (n = 49); and group 3, those with septic shock (n = 32)
We found that the area under the curve (AUC) were greater for the combination of APACHE Acute Physiology and Chronic Health Evaluation II (II) score and soluble urokinase plasminogen activator receptor (suPAR) (0.878 ± 0.042) than for the single APACHE II score or single suPAR (Fig. 3), demonstrating that combination of APACHE II score and suPAR may supply the more powerful prognostic utility for the mortality of sepsis

Summary

Introduction

Risk stratification is the key strategy to improve prognosis of patients with sepsis. Previous study has proposed to develop a powerful risk assessment rule by the combination of Acute Physiology and Chronic Health Evaluation II (APACHE II) score and plasma soluble urokinase plasminogen activator receptor (suPAR). One of the fundamental principles for the appropriate management of sepsis is timely discrimination of the patients at high risk for death [4]. This is generally dependent on the application of score systems and various biological markers are widely explored [6,7,8,9], only a few have been applied in the clinical practice.

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