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Original article
Available online 16 June 2024
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
Un modelo de predicción de mortalidad basado en la combinación de lactato, procalcitonina y calprotectina en pacientes críticos con sepsis: un estudio retrospectivo de acuerdo a la definición Sepsis-3
Luis García de Guadiana-Romualdoa,1,
Corresponding author
guadianarom@yahoo.es

Corresponding author.
, Lourdes Albert Botellab,1, Carlos Rodríguez Rojasa, Angela Puche Candela, Roberto Jimenez Sánchezc, Pablo Conesa Zamoraa, María Dolores Albaladejo-Otóna, José Manuel Allegue-Gallegoc
a Laboratory Medicine Department, Hospital Universitario Santa Lucía, Cartagena, Spain
b Laboratory Medicine Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
c Critical Care Unit, Hospital Universitario Santa Lucía, Cartagena, Spain
Received 06 November 2023. Accepted 09 May 2024
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Figures (2)
Tables (4)
Table 1. Characteristics of patients according to 28-day mortality.
Table 2. ROC curves of biomarker levels to predict 28-day mortality.
Table 3. Optimal cutoffs for biomarkers with a significant accuracy for 28-day mortality.
Table 4. Univariate and multivariate regression analysis for 28-day mortality.
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Abstract
Objective

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.

Design

A single-center, retrospective study.

Setting

Intensive Care Unit of a university hospital.

Patients or participants

One hundred and seventy three septic pacientes were included.

Interventions

Measurement of baseline lactate, procalcitonin and calprotectin level and procalcitonin and calprotectin levels on 24 h.

Main variables of interest

Demographics and comorbidities, SOFA score on ICU admission, baseline lactate, procalcitonin and calprotectin on admission and on 24 h and 28-day mortality.

Results

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.

Conclusions

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.

Keywords:
Sepsis
Procalcitonin
Calprotectin
Lactate
SOFA score
Mortality
Resumen
Objetivo

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.

Diseño

Estudio unicéntrico, retrospectivo.

Ámbito

Unidad de Cuidados Intensivos de un hospital universitario.

Pacientes o participantes

173 pacientes sépticos.

Intervenciones

Medida de las concentraciones basales de lactato, procalcitonina y calprotectina y de procalcitonina y calprotectina a las 24 horas.

Variables de interés principales

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.

Resultados

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 calprotectina sérica, pero sí en el aclaramiento de ambos biomarcadores, que mostraron un rendimiento moderado (AUCs: 0,668 y 0,664); 3) Un modelo combinando biomarcadores bioquímicos alcanzó un rendimiento significativo (AUC: 0,766), con tendencia a incrementar (AUC: 0,829) el de la escala SOFA aislada; y 4) Las concentraciones de lactato basal y el aclaramiento de procalcitonina y calprotectina fueron predictores independientes del evento.

Conclusiones

1) Calprotectina y procalcitonina basal y a las 24 horas carecen de valor para predecir mortalidad a los 28 días; 2) El rendimiento del aclaramiento de ambos fue moderado; y 3) La combinación de la escala SOFA y un modelo combinando los biomarcadores sanguíneos mostró un rendimiento pronóstico alto.

Palabras clave:
Sepsis
Procalcitonina
Calprotectina
Lactato
Escala SOFA
Mortalidad

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