Top

Published in:

Open Access 01-12-2014 | Research

ICG-liver test versus new biomarkers as prognostic markers for prolonged length of stay in critically ill patients - a prospective study of accuracy for prediction of length of stay in the ICU

Authors: Bernhard Zoller, Katharina Spanaus, Rahel Gerster, Mario Fasshauer, Paul A Stehberger, Stephanie Klinzing, Athanasios Vergopoulos, Arnold von Eckardstein, Markus Béchir

Published in: Annals of Intensive Care | Issue 1/2014

Abstract

Background

Prognostic abilities of medical parameters, which are scoring systems, measurements and biomarkers, are important for stratifying critically ill patients. Indocyanine green plasma disappearance (ICG-PDR) is an established clinical tool for the assessment of liver perfusion and function. Copeptin, MR-proANP and pro-ADM are biomarkers whose prognostic value is still unclear. The goal of this prospective study was to evaluate ICG-PDR, copeptin, MR-proANP and pro-ADM to predict prolonged length of stay (pLOS) in the ICU.

Methods

This study was conducted as a prospective single center study including 110 consecutively admitted ICU patients. Primary endpoint was prolonged length of stay (pLOS) in the ICU, defined as more than three days of stay there.

Results

ROC analysis showed an AUC of 0.73 for ICG-PDR, 0.70 for SAPS II, 0.65 for MR-proANP, 0.64 for pro-ADM and 0.54 for copeptin for pLOS in the ICU.

Conclusions

The prediction of pLOS in the ICU might be better by means of ICG-PDR than with the new biomarkers copeptin, MR-proANP or pro-ADM. Nevertheless, there is more need for research to evaluate whether ICG-PDR is an overall prognostic marker for pLOS.

Trial registration

(ClinicalTrials.gov number, NCT01126554).

Stevens V, Lodise TP, Tsuji B, Stringham M, Butterfield J, Dodds Ashley E, Brown K, Forrest A, Brown J: The utility of acute physiology and chronic health evaluation II scores for prediction of mortality among intensive care unit (ICU) and non-ICU patients with methicillin-resistant Staphylococcus aureus bacteremia. Infect Control Hosp Epidemiol 2012,33(6):558–564. 10.1086/665731CrossRefPubMed

Le Gall JR, Lemeshow S, Saulnier F: A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993,270(24):2957–2963. 10.1001/jama.1993.03510240069035CrossRefPubMed

Minne L, Abu-Hanna A, de Jonge E: Evaluation of SOFA-based models for predicting mortality in the ICU: a systematic review. Crit Care 2008,12(6):R161. 10.1186/cc7160PubMedCentralCrossRefPubMed

Vasilevskis EE, Kuzniewicz MW, Cason BA, Lane RK, Dean ML, Clay T, Rennie DJ, Vittinghoff E, Dudley RA: Mortality probability model III and simplified acute physiology score II: assessing their value in predicting length of stay and comparison to APACHE IV. Chest 2009,136(1):89–101. 10.1378/chest.08-2591PubMedCentralCrossRefPubMed

Sakr Y, Marques J, Mortsch S, Gonsalves MD, Hekmat K, Kabisch B, Kohl M, Reinhart K: Is the SAPS II score valid in surgical intensive care unit patients? J Eval Clin Pract 2012,18(2):231–237. 10.1111/j.1365-2753.2010.01559.xCrossRefPubMed

Faybik P, Krenn CG, Baker A, Lahner D, Berlakovich G, Steltzer H, Hetz H: Comparison of invasive and noninvasive measurement of plasma disappearance rate of indocyanine green in patients undergoing liver transplantation: a prospective investigator-blinded study. Liver Transpl 2004,10(8):1060–1064. 10.1002/lt.20205CrossRefPubMed

Sakka SG, Reinhart K, Meier-Hellmann A: Prognostic value of the indocyanine green plasma disappearance rate in critically ill patients. Chest 2002,122(5):1715–1720. 10.1378/chest.122.5.1715CrossRefPubMed

Forestier J, Dumortier J, Guillaud O, Ecochard M, Roman S, Boillot O, Lutringer D, Scoazec JY, Subtil F, Mion F: Noninvasive diagnosis and prognosis of liver cirrhosis: a comparison of biological scores, elastometry, and metabolic liver function tests. Eur J Gastroenterol Hepatol 2010,22(5):532–540. 10.1097/MEG.0b013e3283343f58CrossRefPubMed

de Liguori CN, O’Reilly DA, Dajani K, Ghaneh P, Poston GJ, Wu AV: Perioperative use of the LiMON method of indocyanine green elimination measurement for the prediction and early detection of post-hepatectomy liver failure. Eur J Surg Oncol 2009,35(9):957–962. 10.1016/j.ejso.2009.02.003CrossRef

10.

Nickel CH, Bingisser R, Morgenthaler NG: The role of copeptin as a diagnostic and prognostic biomarker for risk stratification in the emergency department. BMC Med 2012, 10: 7. 10.1186/1741-7015-10-7PubMedCentralCrossRefPubMed

11.

Thibonnier M, Preston JA, Dulin N, Wilkins PL, Berti-Mattera LN, Mattera R: The human V3 pituitary vasopressin receptor: ligand binding profile and density-dependent signaling pathways. Endocrinology 1997,138(10):4109–4122.PubMed

12.

Kruger S, Ewig S, Kunde J, Hanschmann A, Marre R, Suttorp N, Welte T: C-terminal provasopressin (copeptin) in patients with community-acquired pneumonia - influence of antibiotic pre-treatment: results from the German competence network CAPNETZ. J Antimicrob Chemother 2009,64(1):159–162. 10.1093/jac/dkp148CrossRefPubMed

13.

Katan M, Fluri F, Morgenthaler NG, Schuetz P, Zweifel C, Bingisser R, Muller K, Meckel S, Gass A, Kappos L, Steck AJ, Engelter ST, Müller B, Christ-Crain M: Copeptin: a novel, independent prognostic marker in patients with ischemic stroke. Ann Neurol 2009,66(6):799–808. 10.1002/ana.21783CrossRefPubMed

14.

Dong XQ, Huang M, Yang SB, Yu WH, Zhang ZY: Copeptin is associated with mortality in patients with traumatic brain injury. J Trauma 2011,71(5):1194–1198. 10.1097/TA.0b013e31821283f2CrossRefPubMed

15.

Meune C, Twerenbold R, Drexler B, Balmelli C, Wolf C, Haaf P, Reichlin T, Irfan A, Reiter M, Zellweger C, Meissner J, Stelzig C, Freese M, Capodarve I, Mueller C: Midregional pro-A-type natriuretic peptide for diagnosis and prognosis in patients with suspected acute myocardial infarction. Am J Cardiol 2012,109(8):1117–1123. 10.1016/j.amjcard.2011.11.047CrossRefPubMed

16.

Bernasconi M, Tamm M, Bingisser R, Miedinger D, Leuppi J, Muller B, Christ-Crain M, Stolz D: Midregional proatrial natriuretic peptide predicts survival in exacerbations of COPD. Chest 2011,140(1):91–99. 10.1378/chest.10-1353CrossRefPubMed

17.

Bhandari SS, Davies JE, Struck J, Ng LL: Influence of confounding factors on plasma mid-regional pro-adrenomedullin and mid-regional pro-A-type natriuretic peptide concentrations in healthy individuals. Biomarkers 2011,16(3):281–287. 10.3109/1354750X.2011.553750CrossRefPubMed

18.

Stolz D, Christ-Crain M, Morgenthaler NG, Miedinger D, Leuppi J, Muller C, Bingisser R, Struck J, Muller B, Tamm M: Plasma pro-adrenomedullin but not plasma pro-endothelin predicts survival in exacerbations of COPD. Chest 2008,134(2):263–272. 10.1378/chest.08-0047CrossRefPubMed

19.

Meune C, Balmelli C, Twerenbold R, Reiter M, Reichlin T, Ziller R, Drexler B, Stelzig C, Freese M, Wolf C, Haaf P, Osswald S, Mueller C: Utility of 14 novel biomarkers in patients with acute chest pain and undetectable levels of conventional cardiac troponin. Int J Cardiol 2012, ᅟ: ᅟ. doi:10.1016/j.ijcard.2012.03.117

20.

Klip IT, Voors AA, Anker SD, Hillege HL, Struck J, Squire I, van Veldhuisen DJ, Dickstein K: Prognostic value of mid-regional pro-adrenomedullin in patients with heart failure after an acute myocardial infarction. Heart 2011,97(11):892–898. 10.1136/hrt.2010.210948CrossRefPubMed

21.

Miller WL, Hartman KA, Burritt MF, Grill DE, Rodeheffer RJ, Burnett JC Jr, Jaffe AS: Serial biomarker measurements in ambulatory patients with chronic heart failure: the importance of change over time. Circulation 2007,116(3):249–257. 10.1161/CIRCULATIONAHA.107.694562CrossRefPubMed

22.

Shah RV, Truong QA, Gaggin HK, Pfannkuche J, Hartmann O, Januzzi JL Jr: Mid-regional pro-atrial natriuretic peptide and pro-adrenomedullin testing for the diagnostic and prognostic evaluation of patients with acute dyspnoea. Eur Heart J 2012, ᅟ: ᅟ.

23.

Guignant C, Voirin N, Venet F, Lepape A, Monneret G: Persistent high level of circulating midregional-proadrenomedullin and increased risk of nosocomial infections after septic shock. J Trauma Acute Care Surg 2012,72(1):293–296.PubMed

Title: ICG-liver test versus new biomarkers as prognostic markers for prolonged length of stay in critically ill patients - a prospective study of accuracy for prediction of length of stay in the ICU
Authors: Bernhard Zoller
Katharina Spanaus
Rahel Gerster
Mario Fasshauer
Paul A Stehberger
Stephanie Klinzing
Athanasios Vergopoulos
Arnold von Eckardstein
Markus Béchir
Publication date: 01-12-2014
Publisher: Springer Paris
Published in: Annals of Intensive Care / Issue 1/2014
Electronic ISSN: 2110-5820
DOI: https://doi.org/10.1186/s13613-014-0019-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

ICG-liver test versus new biomarkers as prognostic markers for prolonged length of stay in critically ill patients - a prospective study of accuracy for prediction of length of stay in the ICU

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2014

An increase in mean platelet volume after admission is associated with higher mortality in critically ill patients

Iatrogenic salt water drowning and the hazards of a high central venous pressure

Association between initial prescribed minute ventilation and post-resuscitation partial pressure of arterial carbon dioxide in patients with post-cardiac arrest syndrome

Lung ultrasound in the critically ill

Daily sedative interruption versus intermittent sedation in mechanically ventilated critically ill patients: a randomized trial

Accuracy and limitations of continuous glucose monitoring using spectroscopy in critically ill patients