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Biomarkers that might improve prognostic accuracy in ICU patients

Introduction

There is often a discrepancy between physician prediction of mortality and clinical prediction scores, and the accuracy of the latter is rather moderate. Nevertheless, it is tempting to just measure a biochemical parameter – a biomarker – to find prognostic information. Serum lipoproteins, for example, can mirror inflammatory activity and prognosis as well.

Methods

A prospective study of 29 patients that stayed in the ICU for at least 4 days and had the following characteristics: age 62.28 ± 16.92 years, length of stay in the ICU 15.55 ± 10.51 days and APACHE II score 21.28 ± 7.83. C-reactive protein (CRP), total cholesterol and high-density lipoprotein (HDL) were measured on admission and on day 4 in the ICU. First, we correlated these parameters with the length of stay in the ICU using Pearson's correlation method. Secondly, we compared the means between survivors and nonsurvivors after 6 months with an independent-samples' t test. We finally performed receiver operating curves of the above parameters according to mortality.

Results

CRP both on admission and on day 4 was positively correlated with length of stay in the ICU (P < 0.05). Mortality in 6 months was 18/29 (62%). According to the independent-samples' t test, statistical significance (P < 0.05) was only found for CRP on admission. On admission, the values of areas under the curve (AUC) were: CRP = 0.793, HDL = 0.667, total cholesterol = 0.604. Furthermore, on day 4 the values of AUC were: CRP = 0.629, HDL = 0.712 and cholesterol = 0.629. Using a cutoff CRP value on admission of ≤ 0.87 mg/dl, there was a better chance of survival with a sensitivity of 63.6% and a specificity of 94.44% (95% CI = 72.6–99.1). In addition to that, a cutoff HDL value on day 4 of ≥ 28.4 mg/dl predicts survival with a sensitivity of 63.6% and a specificity of 83.3% (95% CI = 46.5–90.2).

Conclusion

Serial measurements of CRP and HDL are both easy to perform and can add prognostic information. On the other hand, total cholesterol seems not to have any prognostic significance.

References

  1. 1.

    Schuetz , et al: Curr Opin Crit Care. 2007, 13: 578-585. 10.1097/MCC.0b013e3282c9ac2a.

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Karvouniaris, M., Stougianni, M., Tefas, A. et al. Biomarkers that might improve prognostic accuracy in ICU patients. Crit Care 12, P173 (2008). https://doi.org/10.1186/cc6394

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Keywords

  • Cholesterol
  • Total Cholesterol
  • Prognostic Significance
  • Biochemical Parameter
  • Good Chance