Score performance of SAPS 2 and SAPS 3 in combination with biomarkers IL-6, PCT or CRP.
Acute Disease
/ mortality
Adolescent
Adult
Aged
Aged, 80 and over
Biomarkers
/ blood
C-Reactive Protein
/ analysis
Critical Care
/ statistics & numerical data
Female
Germany
Hospital Mortality
Hospitals, University
/ statistics & numerical data
Humans
Intensive Care Units
/ statistics & numerical data
Interleukin-6
/ blood
Male
Middle Aged
Procalcitonin
/ blood
Prognosis
Retrospective Studies
Simplified Acute Physiology Score
Young Adult
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2020
2020
Historique:
received:
15
05
2020
accepted:
19
08
2020
entrez:
4
9
2020
pubmed:
4
9
2020
medline:
28
10
2020
Statut:
epublish
Résumé
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. 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. 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). 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.
Identifiants
pubmed: 32881963
doi: 10.1371/journal.pone.0238587
pii: PONE-D-20-14534
pmc: PMC7470390
doi:
Substances chimiques
Biomarkers
0
IL6 protein, human
0
Interleukin-6
0
Procalcitonin
0
C-Reactive Protein
9007-41-4
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0238587Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
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