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Score performance of SAPS 2 and SAPS 3 in combination with biomarkers IL-6, PCT or CRP.

ABSTRACT: OBJECTIVE:We aimed to evaluate the effects of combining the Simplified-Acute-Physiology-Score (SAPS) 2 or the SAPS 3 with Interleukin-6 (IL-6) or Procalcitonin (PCT) or C-Reactive Protein (CRP) concentrations for predicting in-hospital mortality. MATERIAL AND METHODS:This retrospective study was conducted in an interdisciplinary 22-bed intensive care unit (ICU) at a German university hospital. Within an 18-month period, SAPS 2 and SAPS 3 were calculated for 514 critically ill patients that were admitted to the internal medicine department. To evaluate discrimination performance, the area under the receiver operating characteristic curves (AUROCs) and the 95% confidence intervals (95% CIs) were calculated for each score, exclusively or in combination with IL-6 or PCT or CRP. DeLong test was used to compare different AUROCs. RESULTS:The SAPS 2 exhibited a better discrimination performance than SAPS 3 with AUROCs of 0.81 (95% CI, 0.76-0.86) and 0.72 (95% CI, 0.66-0.78), respectively. Overall, combination of the SAPS 2 with IL-6 showed the best discrimination performance (AUROC 0.82; 95% CI, 0.77-0.87), albeit not significantly different from SAPS2. IL-6 performed better than PCT and CRP with AUROCs of 0.75 (95% CI, 0.69-0.81), 0.72 (95% CI, 0.66-0.77) and 0.65 (95% CI, 0.59-0.72), respectively. Performance of the SAPS 3 improved significantly when combined with IL-6 (AUROC 0.76; 95% CI, 0.69-0.81) or PCT (AUROC 0.73; 95% CI, 0.67-0.78). CONCLUSIONS:Our analysis provided evidence that the risk stratification performance of the SAPS 3 and, to a lesser degree, also of the SAPS 2 can increase when combined with IL-6. A more accurate detection of aberrant or dysregulated systemic immunological responses (by IL-6) may explain the higher performance achieved by SAPS 3 + IL-6 vs. SAPS 3. Thus, implementation of IL-6 in critical care scores can improve prediction outcomes, especially in patients experiencing acute inflammatory conditions; however, statistical results may vary across hospital types and/or patient populations with different case mix.

SUBMITTER: Jahn M

PROVIDER: S-EPMC7470390 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Score performance of SAPS 2 and SAPS 3 in combination with biomarkers IL-6, PCT or CRP.

Jahn Michael M Rekowski Jan J Jánosi Rolf Alexander RA Kribben Andreas A Canbay Ali A Katsounas Antonios A

PloS one 20200903 9

<h4>Objective</h4>We aimed to evaluate the effects of combining the Simplified-Acute-Physiology-Score (SAPS) 2 or the SAPS 3 with Interleukin-6 (IL-6) or Procalcitonin (PCT) or C-Reactive Protein (CRP) concentrations for predicting in-hospital mortality.<h4>Material and methods</h4>This retrospective study was conducted in an interdisciplinary 22-bed intensive care unit (ICU) at a German university hospital. Within an 18-month period, SAPS 2 and SAPS 3 were calculated for 514 critically ill pati ...[more]

PMID: 32881963

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Project description:BackgroundIt is difficult to diagnose ascites infection early in cirrhotic patients. The present study was to create and evaluate a new bioscore combined with PCT, sNFI and dCHC in the diagnosis of ascites infection in cirrhotic patients.MethodsTwo hundred and fifty-nine consecutive patients were enrolled; of which 51 patients were culture-positive spontaneous bacterial peritonitis (culture-positive SBP) and 58 patients were culture-negative SBP. The efficacy of procalcitonin(PCT), c-reactive protein (CRP), white blood cell (WBC), mean fluorescence intensity of mature neutrophils(sNFI) and difference in hemoglobin concentration between newly formed and mature red blood cells(dCHC) for diagnosing ascites infection was examined. These parameters were used to create a scoring system. The scoring system was analyzed by logistic regression analysis to determine which parameters were statistically different between ascites infection and non-ascites infection patients. Receiver operating characteristic curve (ROC) was used to analyze the diagnostic ability of bioscore for ascites infection.ResultsIn ROC analysis, the area under the curves (AUC) for PCT was 0.852 (95% CI 0.803-0.921, P?<?0.001), dCHC 0.837 (95% CI 0.773-0.923, P?<?0.001), CRP 0.669 (95% CI 0.610-0.732, P?=?0.0624), sNFI 0.838 (95% CI 0.777-0.903, P?<?0.001), and WBC 0.624 (95% CI 0.500-0.722, P?=?0.0881). Multivariate analysis revealed PCT, dCHC and sNFI to be statistically significant. The combination of these three parameters in the bioscore had an AUC of 0.937 (95% CI 0.901-0.994, P?<?0.001). A bioscore of ?3.40 was considered to be statistically significant in making a positive diagnosis of ascites infection. In different groups of ascites infection, bioscore also shown a high diagnostic value of AUC was 0.947(95% CI 0.882-0.988, P?<?0.001) and 0.929 (95% CI 0.869-0.974, P?<?0.001) for culture-positive SBP and culture-negative SBP group respectively.ConclusionThe composite markers of combining PCT, dCHC and sNFI could be a valuable diagnostic score to early diagnose ascites infection in patients with cirrhosis.

Dataset Information

Score performance of SAPS 2 and SAPS 3 in combination with biomarkers IL-6, PCT or CRP.

Publications

Score performance of SAPS 2 and SAPS 3 in combination with biomarkers IL-6, PCT or CRP.

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