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

被引:7
作者
Jahn, Michael [1 ]
Rekowski, Jan [2 ]
Janosi, Rolf Alexander [3 ]
Kribben, Andreas [1 ]
Canbay, Ali [4 ]
Katsounas, Antonios [4 ]
机构
[1] Univ Duisburg Essen, Univ Hosp Essen, Dept Nephrol, Essen, Germany
[2] Univ Duisburg Essen, Univ Hosp Essen, Inst Med Informat Biometry & Epidemiol, Essen, Germany
[3] Univ Duisburg Essen, Univ Hosp Essen, West German Heart & Vasc Ctr, Dept Cardiol & Vasc Med, Essen, Germany
[4] Ruhr Univ Bochum, Univ Klinikum Knappschaftskrankenhaus Bochum GmbH, Dept Med, Bochum, Germany
来源
PLOS ONE | 2020年 / 15卷 / 09期
关键词
INTENSIVE-CARE-UNIT; RESPIRATORY-DISTRESS-SYNDROME; C-REACTIVE PROTEIN; HOSPITAL MORTALITY; CRITICALLY-ILL; ORGAN FAILURE; CARDIOGENIC-SHOCK; APACHE-III; INTERLEUKIN-6; PROCALCITONIN;
D O I
10.1371/journal.pone.0238587
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
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.
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页数:14
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