Abstract
BackgroundShock and organ damage occur in critically ill patients in the emergency department because of biological responses to invasion, and cytokines play an important role in their development. It is important to predict early multiple organ dysfunction (MOD) because it is useful in predicting patient outcomes and selecting treatment strategies. This study examined the accuracy of biomarkers, including interleukin (IL)-6, in predicting early MOD in critically ill patients compared with that of quick sequential organ failure assessment (qSOFA).MethodsThis was a multicenter observational sub-study. Five universities from 2016 to 2018. Data of adult patients with systemic inflammatory response syndrome who presented to the emergency department or were admitted to the intensive care unit were prospectively evaluated. qSOFA score and each biomarker (IL-6, IL-8, IL-10, tumor necrosis factor-α, C-reactive protein, and procalcitonin [PCT]) level were assessed on Days 0, 1, and 2. The primary outcome was set as MOD on Day 2, and the area under the curve (AUC) was analyzed to evaluate qSOFA scores and biomarker levels.ResultsOf 199 patients, 38 were excluded and 161 were included. Patients with MOD on Day 2 had significantly higher qSOFA, SOFA, and Acute Physiology and Chronic Health Evaluation II scores and a trend toward worse prognosis, including mortality. The AUC for qSOFA score (Day 0) that predicted MOD (Day 2) was 0.728 (95% confidence interval [CI]: 0.651–0.794). IL-6 (Day 1) showed the highest AUC among all biomarkers (0.790 [95% CI: 0.711–852]). The combination of qSOFA (Day 0) and IL-6 (Day 1) showed improved prediction accuracy (0.842 [95% CI: 0.771–0.893]). The combination model using qSOFA (Day 1) and IL-6 (Day 1) also showed a higher AUC (0.868 [95% CI: 0.799–0.915]). The combination model of IL-8 and PCT also showed a significant improvement in AUC.ConclusionsThe addition of IL-6, IL-8 and PCT to qSOFA scores improved the accuracy of early MOD prediction.
Highlights
Shock and organ damage occur in critically ill patients in the emergency department because of biological responses to invasion, and cytokines play an important role in their development
The biomarkers and days with the highest area under the curve (AUC) were used in the model added to quick sequential organ failure assessment (qSOFA) to evaluate whether the model improves the accuracy of predicting multiple organ dysfunction (MOD)
Of 199 patients enrolled in the study: 5 who withdrew their consent, 4 who were on steroids before admission, 7 who died within 48 h of admission, 1 who was discharged within 48 h of admission, and 21 who had deviated from the protocol for biomarker testing and Sequential organ failure assessment (SOFA) score calculation due to missing samples or improper timing of the sampling
Summary
This study examined the accuracy of biomarkers, including interleukin (IL)-6, in predicting early MOD in critically ill patients compared with that of quick sequential organ failure assessment (qSOFA). The in-hospital mortality predictive effectiveness of qSOFA was statistically higher than that of SOFA in cases of suspected infection outside the ICU [8]. QSOFA is affected by the severity of infection and quality of the health care system, and factors such as biomarkers that correlate with systemic inflammation are not included in the score. The addition of simple blood tests, including those of cytokines, as in the present study, may improve the diagnostic accuracy of qSOFA for sepsis [9,10,11]
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