Skip to main content
Top
Published in: BMC Anesthesiology 1/2015

Open Access 01-12-2015 | Research article

Prognostic significance of APACHE II score and plasma suPAR in Chinese patients with sepsis: a prospective observational study

Authors: Xuan Liu, Yong Shen, Zhihua Li, Aihua Fei, Hairong Wang, Qinmin Ge, Shuming Pan

Published in: BMC Anesthesiology | Issue 1/2015

Login to get access

Abstract

Background

Timely risk stratification is the key strategy to improve prognosis of patients with sepsis. Previous study has proposed to develop a powerful risk assessment rule by the combination of Acute Physiology and Chronic Health Evaluation II (APACHE II) score and plasma soluble urokinase plasminogen activator receptor (suPAR). That reaffirmation of suPAR as a prognostic marker in Chinese patients with severe sepsis is the aim of the study.

Methods

A total of 137 consecutive Chinese patients with sepsis were enrolled in a prospective study cohort. Demographic and clinical characteristics, conventional risk factors and important laboratory data were prospectively recorded. Sequential plasma suPAR concentrations were measured by an enzymeimmunoabsorbent assay on days 1, 3, and 7 after admission to the intensive care unit (ICU). Receiver operating characteristic (ROC) curves and Cox regression analysis were used to examine the performance of suPAR in developing a rule for risk stratification.

Results

The results showed that plasma suPAR concentrations remained relatively stable within survivors and non-survivors during the first week of disease course. Regression analysis indicated that APACHE II ≥15 and suPAR ≥10.82 ng/mL were independently associated with unfavorable outcome. With the above cutoffs of APACHE II and suPAR, strata of disease severity were determined. The mortality of each stratum differed significantly from the others.

Conclusions

Combination of APACHE II score and suPAR may supply the powerful prognostic utility for the mortality of sepsis.
Literature
1.
go back to reference ARISE Investigators; ANZICS Clinical Trials Group, Peake SL, Delaney A, Bailey M, Bellomo R, Cameron PA, Cooper DJ, Higgins AM, Holdgate A, Howe BD, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014;371:1496–506.CrossRef ARISE Investigators; ANZICS Clinical Trials Group, Peake SL, Delaney A, Bailey M, Bellomo R, Cameron PA, Cooper DJ, Higgins AM, Holdgate A, Howe BD, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014;371:1496–506.CrossRef
2.
go back to reference Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000–2012. JAMA. 2014;311:1308–16.CrossRefPubMed Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000–2012. JAMA. 2014;311:1308–16.CrossRefPubMed
3.
go back to reference Reinhart K, Daniels R, Kissoon N, O'Brien J, Machado FR, Jimenez E, GSA Executive Board and WSD Executive Board. The burden of sepsis-a call to action in support of World Sepsis Day 2013. J Crit Care. 2013;28:526–8.CrossRefPubMed Reinhart K, Daniels R, Kissoon N, O'Brien J, Machado FR, Jimenez E, GSA Executive Board and WSD Executive Board. The burden of sepsis-a call to action in support of World Sepsis Day 2013. J Crit Care. 2013;28:526–8.CrossRefPubMed
4.
go back to reference Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39:165–228.CrossRefPubMed Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39:165–228.CrossRefPubMed
5.
go back to reference Giamarellos-Bourboulis EJ, Norrby-Teglund A, Mylona V, Savva A, Tsangaris I, Dimopoulou I, Mouktaroudi M, Raftogiannis M, Georgitsi M, Linnér A, et al. Risk assessment in sepsis:a new prognostication rule by APACHE II score and serum soluble urokinaseplasminogen activator receptor. Crit Care. 2012;16:R149.CrossRefPubMedPubMedCentral Giamarellos-Bourboulis EJ, Norrby-Teglund A, Mylona V, Savva A, Tsangaris I, Dimopoulou I, Mouktaroudi M, Raftogiannis M, Georgitsi M, Linnér A, et al. Risk assessment in sepsis:a new prognostication rule by APACHE II score and serum soluble urokinaseplasminogen activator receptor. Crit Care. 2012;16:R149.CrossRefPubMedPubMedCentral
6.
go back to reference Vera S, Martínez R, Gormaz JG, Gajardo A, Galleguillos F, Rodrigo R. Novel relationships between oxidative stress and angiogenesis-related factors in sepsis: New biomarkers and therapies. Ann Med. 2015;47:289–300.CrossRefPubMed Vera S, Martínez R, Gormaz JG, Gajardo A, Galleguillos F, Rodrigo R. Novel relationships between oxidative stress and angiogenesis-related factors in sepsis: New biomarkers and therapies. Ann Med. 2015;47:289–300.CrossRefPubMed
7.
go back to reference Hong DY, Kim JW, Paik JH, Jung HM, Baek KJ, Park SO, Lee KR. Value of plasma neutrophil gelatinase-associated lipocalin in predicting the mortality of patients with sepsis at the emergency department. Clin Chim Acta. 2015;452:177–81.CrossRefPubMed Hong DY, Kim JW, Paik JH, Jung HM, Baek KJ, Park SO, Lee KR. Value of plasma neutrophil gelatinase-associated lipocalin in predicting the mortality of patients with sepsis at the emergency department. Clin Chim Acta. 2015;452:177–81.CrossRefPubMed
8.
go back to reference Linder A, Arnold R, Boyd JH, Zindovic M, Zindovic I, Lange A, Paulsson M, Nyberg P, Russell JA, Pritchard D, et al. Heparin-Binding Protein Measurement Improves the Prediction of Severe Infection With Organ Dysfunction in the Emergency Department. Crit Care Med. 2015;43:2378–86.CrossRefPubMedPubMedCentral Linder A, Arnold R, Boyd JH, Zindovic M, Zindovic I, Lange A, Paulsson M, Nyberg P, Russell JA, Pritchard D, et al. Heparin-Binding Protein Measurement Improves the Prediction of Severe Infection With Organ Dysfunction in the Emergency Department. Crit Care Med. 2015;43:2378–86.CrossRefPubMedPubMedCentral
9.
go back to reference Hur M, Kim H, Kim HJ, Yang HS, Magrini L, Marino R, Cardelli P, Di Somma S, GREAT Network. Soluble ST2 has a prognostic role in patients with suspected sepsis. Ann Lab Med. 2015;35:570–7.CrossRefPubMedPubMedCentral Hur M, Kim H, Kim HJ, Yang HS, Magrini L, Marino R, Cardelli P, Di Somma S, GREAT Network. Soluble ST2 has a prognostic role in patients with suspected sepsis. Ann Lab Med. 2015;35:570–7.CrossRefPubMedPubMedCentral
10.
go back to reference Backes Y, van der Sluijs KF, Mackie DP, Tacke F, Koch A, Tenhunen JJ, Schultz MJ. Usefulness of suPAR as a biological marker in patients with systemic inflammation or infection: a systematic review. Intensive Care Med. 2012;38:1418–28.CrossRefPubMedPubMedCentral Backes Y, van der Sluijs KF, Mackie DP, Tacke F, Koch A, Tenhunen JJ, Schultz MJ. Usefulness of suPAR as a biological marker in patients with systemic inflammation or infection: a systematic review. Intensive Care Med. 2012;38:1418–28.CrossRefPubMedPubMedCentral
11.
go back to reference Madsen CD, Sidenius N. The interaction between urokinase receptor and vitronectin in cell adhesion and signaling. Eur J Cell Biol. 2008;87:617–29.CrossRefPubMed Madsen CD, Sidenius N. The interaction between urokinase receptor and vitronectin in cell adhesion and signaling. Eur J Cell Biol. 2008;87:617–29.CrossRefPubMed
12.
go back to reference Mekonnen G, Corban MT, Hung OY, Eshtehardi P, Eapen DJ, Al-Kassem H, Rasoul-Arzrumly E, Gogas BD, McDaniel MC, Pielak T, et al. Plasma soluble urokinase-type plasminogen activator receptor level is independently associated with coronary microvascular function in patients with non-obstructive coronary artery disease. Atherosclerosis. 2015;239:55–60.CrossRefPubMed Mekonnen G, Corban MT, Hung OY, Eshtehardi P, Eapen DJ, Al-Kassem H, Rasoul-Arzrumly E, Gogas BD, McDaniel MC, Pielak T, et al. Plasma soluble urokinase-type plasminogen activator receptor level is independently associated with coronary microvascular function in patients with non-obstructive coronary artery disease. Atherosclerosis. 2015;239:55–60.CrossRefPubMed
13.
go back to reference Tzanakaki G, Paparoupa M, Kyprianou M, Barbouni A, Eugen-Olsen J, Kourea-Kremastinou J. Elevated soluble urokinase receptor values in CSF, age and bacterial meningitis infection are independent and additive risk factors of fatal outcome. Eur J Clin Microbiol Infect Dis. 2012;31:1157–62.CrossRefPubMed Tzanakaki G, Paparoupa M, Kyprianou M, Barbouni A, Eugen-Olsen J, Kourea-Kremastinou J. Elevated soluble urokinase receptor values in CSF, age and bacterial meningitis infection are independent and additive risk factors of fatal outcome. Eur J Clin Microbiol Infect Dis. 2012;31:1157–62.CrossRefPubMed
14.
go back to reference Huttunen R, Syrjänen J, Vuento R, Hurme M, Huhtala H, Laine J, Pessi T, Aittoniemi J. Plasma level of soluble urokinase-type plasminogen activator receptor as a predictor of disease severity and case fatality in patients with bacteraemia: a prospective cohort study. J Intern Med. 2011;270:32–40.CrossRefPubMed Huttunen R, Syrjänen J, Vuento R, Hurme M, Huhtala H, Laine J, Pessi T, Aittoniemi J. Plasma level of soluble urokinase-type plasminogen activator receptor as a predictor of disease severity and case fatality in patients with bacteraemia: a prospective cohort study. J Intern Med. 2011;270:32–40.CrossRefPubMed
15.
go back to reference Koch A, Voigt S, Kruschinski C, Sanson E, Dückers H, Horn A, Yagmur E, Zimmermann H, Trautwein C, Tacke F. Circulating soluble urokinase plasminogen activator receptor is stably elevated during the first week of treatment in the intensive care unit and predicts mortality in critically ill patients. Crit Care. 2011;15:R63.CrossRefPubMedPubMedCentral Koch A, Voigt S, Kruschinski C, Sanson E, Dückers H, Horn A, Yagmur E, Zimmermann H, Trautwein C, Tacke F. Circulating soluble urokinase plasminogen activator receptor is stably elevated during the first week of treatment in the intensive care unit and predicts mortality in critically ill patients. Crit Care. 2011;15:R63.CrossRefPubMedPubMedCentral
16.
go back to reference Hoenigl M, Raggam RB, Wagner J, Valentin T, Leitner E, Seeber K, Zollner-Schwetz I, Krammer W, Prüller F, Grisold AJ, et al. Diagnostic accuracy of soluble urokinase plasminogen activator receptor (suPAR) for prediction of bacteremia in patients with systemic inflammatory response syndrome. Clin Biochem. 2013;46:225–9.CrossRefPubMed Hoenigl M, Raggam RB, Wagner J, Valentin T, Leitner E, Seeber K, Zollner-Schwetz I, Krammer W, Prüller F, Grisold AJ, et al. Diagnostic accuracy of soluble urokinase plasminogen activator receptor (suPAR) for prediction of bacteremia in patients with systemic inflammatory response syndrome. Clin Biochem. 2013;46:225–9.CrossRefPubMed
17.
go back to reference Okulu E, Arsan S, Akin IM, Ates C, Alan S, Kilic A, Atasay B. Serum Levels of Soluble Urokinase Plasminogen Activator Receptor in Infants with Late-onset Sepsis. J Clin Lab Anal. 2015;29:347–52.CrossRefPubMed Okulu E, Arsan S, Akin IM, Ates C, Alan S, Kilic A, Atasay B. Serum Levels of Soluble Urokinase Plasminogen Activator Receptor in Infants with Late-onset Sepsis. J Clin Lab Anal. 2015;29:347–52.CrossRefPubMed
18.
go back to reference Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G, SCCM/ESICM/ACCP/ATS/SIS. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med. 2003;31:1250–6.CrossRefPubMed Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G, SCCM/ESICM/ACCP/ATS/SIS. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med. 2003;31:1250–6.CrossRefPubMed
19.
go back to reference Corrêa TD, Sanches PR, de Morais LC, Scarin FC, Silva E, Barbas CS. Performance of noninvasive ventilation in acute respiratory failure in critically ill patients: a prospective, observational, cohort study. BMC Pulm Med. 2015;15:144.CrossRefPubMedPubMedCentral Corrêa TD, Sanches PR, de Morais LC, Scarin FC, Silva E, Barbas CS. Performance of noninvasive ventilation in acute respiratory failure in critically ill patients: a prospective, observational, cohort study. BMC Pulm Med. 2015;15:144.CrossRefPubMedPubMedCentral
20.
go back to reference Vincent JL, Opal SM, Marshall JC. Ten reasons why we should NOT use severity scores as entry criteria for clinical trials or in our treatment decisions. Crit Care Med. 2010;38:283–7.CrossRefPubMed Vincent JL, Opal SM, Marshall JC. Ten reasons why we should NOT use severity scores as entry criteria for clinical trials or in our treatment decisions. Crit Care Med. 2010;38:283–7.CrossRefPubMed
21.
go back to reference Can Ü, Güzelant A, Yerlikaya FH, Yosunkaya Ş. The role of serum soluble urokinase-type plasminogen activator receptor in stable chronic obstructive pulmonary disease. J Investig Med. 2014;62:938–43.CrossRefPubMed Can Ü, Güzelant A, Yerlikaya FH, Yosunkaya Ş. The role of serum soluble urokinase-type plasminogen activator receptor in stable chronic obstructive pulmonary disease. J Investig Med. 2014;62:938–43.CrossRefPubMed
22.
go back to reference Geboers DG, de Beer FM, Tuip-de Boer AM, van der Poll T, Horn J, Cremer OL, Bonten MJ, Ong DS, Schultz MJ, Bos LD. Plasma suPAR as a prognostic biological marker for ICU mortality in ARDS patients. Intensive Care Med. 2015;41:1281–90.CrossRefPubMed Geboers DG, de Beer FM, Tuip-de Boer AM, van der Poll T, Horn J, Cremer OL, Bonten MJ, Ong DS, Schultz MJ, Bos LD. Plasma suPAR as a prognostic biological marker for ICU mortality in ARDS patients. Intensive Care Med. 2015;41:1281–90.CrossRefPubMed
23.
go back to reference Jawad I, Lukšić I, Rafnsson SB. Assessing available information on the burden of sepsis: global estimates of incidence, prevalence and mortality. J Glob Health. 2012;2:010404.CrossRefPubMedPubMedCentral Jawad I, Lukšić I, Rafnsson SB. Assessing available information on the burden of sepsis: global estimates of incidence, prevalence and mortality. J Glob Health. 2012;2:010404.CrossRefPubMedPubMedCentral
24.
go back to reference Gaieski DF, Edwards JM, Kallan MJ, Carr BG. Benchmarking the incidence and mortality of severe sepsis in the United States. Crit Care Med. 2013;41:1167–74.CrossRefPubMed Gaieski DF, Edwards JM, Kallan MJ, Carr BG. Benchmarking the incidence and mortality of severe sepsis in the United States. Crit Care Med. 2013;41:1167–74.CrossRefPubMed
25.
go back to reference Harrison DA, Welch CA, Eddleston JM. The epidemiology of severe sepsis in England, Wales and Northern Ireland, 1996 to 2004: secondary analysis of a high quality clinical database, the ICNARC Case Mix Programme Database. Crit Care. 2006;10:R42.CrossRefPubMedPubMedCentral Harrison DA, Welch CA, Eddleston JM. The epidemiology of severe sepsis in England, Wales and Northern Ireland, 1996 to 2004: secondary analysis of a high quality clinical database, the ICNARC Case Mix Programme Database. Crit Care. 2006;10:R42.CrossRefPubMedPubMedCentral
Metadata
Title
Prognostic significance of APACHE II score and plasma suPAR in Chinese patients with sepsis: a prospective observational study
Authors
Xuan Liu
Yong Shen
Zhihua Li
Aihua Fei
Hairong Wang
Qinmin Ge
Shuming Pan
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2015
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-016-0212-3

Other articles of this Issue 1/2015

BMC Anesthesiology 1/2015 Go to the issue