Mortality prediction model from combined serial lactate, procalcitonin and calprotectin levels in critically ill patients with sepsis: A retrospective study according to Sepsis-3 definition

• Published in: Medicina intensiva 2024-11, Vol.48 (11), p.629-638
• Main Authors: García de Guadiana-Romualdo, Luis, Botella, Lourdes Albert, Rodríguez Rojas, Carlos, Puche Candel, Angela, Jimenez Sánchez, Roberto, Conesa Zamora, Pablo, Albaladejo-Otón, María Dolores, Allegue-Gallego, José Manuel
• Format: Article
• Language: English
• Subjects: Aged; Biomarkers - blood; Calprotectin; Calprotectina; Critical Illness - mortality; Escala SOFA; Female; Humans; Intensive Care Units; Lactate; Lactato; Lactic Acid - blood; Leukocyte L1 Antigen Complex - blood; Male; Middle Aged; Mortalidad; Mortality; Organ Dysfunction Scores; Predictive Value of Tests; Procalcitonin; Procalcitonin - blood; Procalcitonina; Prognosis; Retrospective Studies; Sepsis; Sepsis - blood; Sepsis - mortality; SOFA score
• ISSN: 0210-5691; 2173-5727
• DOI: 10.1016/j.medin.2024.05.004

1) To evaluate the ability of baseline and on 24 h serum calprotectin, in comparison to canonical biomarkers (lactate and procalcitonin), for prognosis of 28-day mortality in critically ill septic patients; and 2) To develop a predictive model combining the three biomarkers. A single-center, retrospective study. Intensive Care Unit of a university hospital. One hundred and seventy three septic pacientes were included. Measurement of baseline lactate, procalcitonin and calprotectin level and procalcitonin and calprotectin levels on 24 h. Demographics and comorbidities, SOFA score on ICU admission, baseline lactate, procalcitonin and calprotectin on admission and on 24 h and 28-day mortality. 1) On ICU admission, lactate was the only biomarker achieving a significant accuracy (AUC: 0.698); 2) On 24 h, no differences were found on procalcitonin and calprotectin levels. Procalcitonin and calprotectin clearances were significantly lower in non-survivors and both achieved a moderate performance (AUCs: 0.668 and 0.664, respectively); 3) A biomarker based-model achieved a significant accuracy (AUC: 0.766), trending to increase (AUC: 0.829) to SOFA score alone; y 4) Baseline lactate levels and procalcitonin and calprotectin clearance were independent predictors for the outcome. 1) Baseline and on 24 h calprotectina and procalcitonin levels lacked ability in predicting 28-day mortality; 2) Accuracy of clearance of both biomarkers was moderate; and 3) Combination of SOFA score and the predictive biomarker based-model showed a high prognostic accuracy. 1) Valorar en pacientes críticos sépticos la capacidad de la medida basal y a las 24 horas de calprotectina sérica, en comparación con marcadores convencionales (lactato y procalcitonina), para predecir mortalidad a los 28 días; y 2) Generar un modelo predictivo basado en la combinación de biomarcadores. Estudio unicéntrico, retrospectivo. Unidad de Cuidados Intensivos de un hospital universitario. 173 pacientes sépticos. Medida de las concentraciones basales de lactato, procalcitonina y calprotectina y de procalcitonina y calprotectina a las 24 horas. Datos demográficos y comorbilidades, escala SOFA al ingreso, lactato al ingreso, y procalcitonina y calprotectina basal y a las 24 horas y mortalidad a los 28 días. 1) Al ingreso, el lactato fue el único biomarcador con un rendimiento predictivo significativo (AUC: 0,698); 2) A las 24 horas no se observaron diferencias en las concentraciones de procalcitonina y calprotect