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Pancreatic stone protein as an early biomarker predicting mortality in a prospective cohort of patients with sepsis requiring ICU management
Critical Care, 07/03/2012
Clinical Article
Que YA et al. – Measurement of pancreatic stone protein/regenerating protein (PSP/reg) concentration within 24h of intensive care unit (ICU) admission may predict in–hospital mortality in patients with septic shock, identifying patients who may benefit most from tailored ICU management.
Methods- PSP/reg, CRP, PCT, tumor necrosis factor–alpha (TNF–alpha, interleukin 1 beta (IL1–beta, IL–6 and IL–8 were prospectively measured in cohort of patients [greater than or equal to]18 years of age with severe sepsis or septic shock within 24h of admission in medico–surgical intensive care unit (ICU) of a community and referral university hospital, and the ability to predict in–hospital mortality was determined.
- The authors evaluated 107 patients, 33 with severe sepsis and 74 with septic shock, with in–hospital mortality rates of 6% (2/33) and 25% (17/74), respectively.
- Plasma concentrations of PSP/reg (343.5 vs. 73.5ng/ml, P<0.001), PCT (39.3 vs. 12.0ng/ml, P<0.001), IL–8 (682 vs. 184ng/ml, P<0.001) and IL–6 (1955 vs. 544pg/ml, P<0.01) were significantly higher in patients with septic shock than with severe sepsis.
- Of note, median PSP/reg was 13.0ng/ml (IQR:4.8) in 20 severe burned patients without infection.
- The area under the ROC curve for PSP/reg (0.65 [95% CI:0.51 to 0.80]) was higher than for CRP (0.44 [0.29 to 0.60]), PCT 0.46 [0.29 to 0.61]), IL–8 (0.61 [0.43 to 0.77]) or IL–6 (0.59 [0.44 to 0.75]) in predicting in–hospital mortality.
- In patients with septic shock, PSP/reg was the only biomarker associated with in–hospital mortality (P=0.049).
- Risk of mortality increased continuously for each ascending quartile of PSP/reg.