226. Combined Biomarkers Discriminate Mortality Risk Among Critically Ill Patients with Suspected Sepsis
Session: Poster Abstract Session: Diagnostics: Use of Biomarkers
Thursday, October 27, 2016
Room: Poster Hall
Background: Sepsis is associated with high in-hospital and absolute mortality. Clinical diagnostic criteria for sepsis have recently been revised to improve their predictive validity for mortality. We performed dense longitudinal sampling of 9 biomarkers in a cohort of medical and surgical intensive care unit (ICU) patients with suspected sepsis to determine the utility of biomarkers as an adjunct to clinical criteria.

Methods: We enrolled 139 subjects who met two or more systemic inflammatory response syndrome (SIRS) criteria from two ICUs at an academic medical center and assayed 9 biomarkers (α-2 macroglobulin, C-reactive protein, ferritin, fibrinogen, haptoglobin, procalcitonin, serum amyloid A, serum amyloid P [SAP], and tissue plasminogen activator [TPA]) at time of suspected sepsis, 24-, 48-, and 72-hours after. We compared biomarkers between groups based on both 14-day and total mortality. We also evaluated the predictive validity of individual biomarkers and biomarker pairs via area under the receiver operating characteristic curve (AUC).

Results: SAP and TPA demonstrated significant differences between groups at 7 of 8 tested timepoints for 14-day mortality and at all timepoints for total mortality (Wilcoxon p < 0.03 for all). SAP at 48 hours had an AUC of 0.70 for both 14-day and total mortality; TPA at 72 hours had an AUC of 0.72 for 14-day and 0.67 for total mortality. Combinations of biomarkers including SAP and TPA achieved greater predictive performance, with AUC greater than 0.76 for 14-day and 0.74 for total mortality.

Conclusion: Combined biomarkers discriminate critically ill subjects with suspected sepsis who are at greater risk for 14-day and total mortality. SAP and TPA demonstrated the best discriminatory ability in this cohort.

Brendan Kelly, MD, MS1, Ebbing Lautenbach, MD, MPH, MSCE, FIDSA, FSHEA2, Irving Nachamkin, DrPH, MPH, FIDSA3, Susan Coffin, MD, MPH, FSHEA, FPIDS4, Jeffrey S. Gerber, MD, PhD4, Barry Fuchs, MD5, Charles Garrigan, MB3, Xiaoyan Han, MS6, Warren Bilker, PhD6, Jacqueleen Wise, BA6, Pam Tolomeo, MPH6, Jennifer Han, MD, MSCE7 and Centers for Disease Control and Prevention (CDC) Prevention Epicenters Program, (1)Division of Infectious Diseases, University of Pennsylvania, Philadelphia, PA, (2)University of Pennsylvania School of Medicine, Philadelphia, PA, (3)Department of Pathology and Laboratory Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, (4)Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, (5)Division of Pulmonary Medicine and Critical Care, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, (6)Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, (7)Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA

Disclosures:

B. Kelly, None

E. Lautenbach, None

I. Nachamkin, None

S. Coffin, CDC: Grant Investigator , Research grant
AHRQ: Grant Investigator , Research grant
NIH: Grant Investigator , Research support

J. S. Gerber, None

B. Fuchs, None

C. Garrigan, None

X. Han, None

W. Bilker, None

J. Wise, None

P. Tolomeo, None

J. Han, None

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