Risk assessment in sepsis: a new prognostication rule by APACHE II score and serum soluble urokinase plasminogen activator receptor

• Published in: Critical care (London, England) Vol. 16; no. 4; p. R149
• Main Authors: Giamarellos-Bourboulis, Evangelos J, Norrby-Teglund, Anna, Mylona, Vassiliki, Savva, Athina, Tsangaris, Iraklis, Dimopoulou, Ioanna, Mouktaroudi, Maria, Raftogiannis, Maria, Georgitsi, Marianna, Linnér, Anna, Adamis, George, Antonopoulou, Anastasia, Apostolidou, Efterpi, Chrisofos, Michael, Katsenos, Chrisostomos, Koutelidakis, Ioannis, Kotzampassi, Katerina, Koratzanis, George, Koupetori, Marina, Kritselis, Ioannis, Lymberopoulou, Korina, Mandragos, Konstantinos, Marioli, Androniki, Sundén-Cullberg, Jonas, Mega, Anna, Prekates, Athanassios, Routsi, Christina, Gogos, Charalambos, Treutiger, Carl-Johan, Armaganidis, Apostolos, Dimopoulos, George
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 01-01-2012; BioMed Central
• Subjects: APACHE; Biomarkers - blood; Care and treatment; Double-Blind Method; Enzymes; Female; Greece - epidemiology; Health aspects; Humans; Intensive Care Units; Kaplan-Meier Estimate; Male; Medical research; Medicin och hälsovetenskap; Medicine, Experimental; Middle Aged; Mortality; plasminogen; Prediction; Prognosis; Prospective Studies; Receptors, Urokinase Plasminogen Activator - blood; Regression Analysis; Risk assessment; Risk Assessment - methods; ROC Curve; Sepsis; Sepsis - diagnosis; Sepsis - mortality; Septic shock; Shock; Shock, Septic - diagnosis; Shock, Septic - mortality; Stratification; Sweden - epidemiology; Taiwan; Thrombolytic drugs; u-Plasminogen activator; Greece; Sweden; Taiwan
• ISSN: 1364-8535; 1466-609X; 1466-609X; 1364-8535
• DOI: 10.1186/cc11463

Early risk assessment is the mainstay of management of patients with sepsis. APACHE II is the gold standard prognostic stratification system. A prediction rule that aimed to improve prognostication by APACHE II with the application of serum suPAR (soluble urokinase plasminogen activator receptor) is developed.
A prospective study cohort enrolled 1914 patients with sepsis including 62.2% with sepsis and 37.8% with severe sepsis/septic shock. Serum suPAR was measured in samples drawn after diagnosis by an enzyme-immunoabsorbent assay; in 367 patients sequential measurements were performed. After ROC analysis and multivariate logistic regression analysis a prediction rule for risk was developed. The rule was validated in a double-blind fashion by an independent confirmation cohort of 196 sepsis patients, predominantly severe sepsis/septic shock patients, from Sweden.
Serum suPAR remained stable within survivors and non-survivors for 10 days. Regression analysis showed that APACHE II ≥ 17 and suPAR ≥ 12 ng/ml were independently associated with unfavorable outcome. Four strata of risk were identified: i) APACHE II <17 and suPAR <12 ng/ml with mortality 5.5%; ii) APACHE II < 17 and suPAR ≥ 12 ng/ml with mortality 17.4%; iii) APACHE II ≥ 17 and suPAR <12 ng/ml with mortality 37.4%; and iv) APACHE II ≥ 17 and suPAR ≥ 12 ng/ml with mortality 51.7%. This prediction rule was confirmed by the Swedish cohort.
A novel prediction rule with four levels of risk in sepsis based on APACHE II score and serum suPAR is proposed. Prognostication by this rule is confirmed by an independent cohort.