Cut-offs for Sepsis in the Intensive Care Unit (ICU)

In a study of 1089 ICU patients, predominantly with septic shock according to the sepsis-2 (87.1%) or sepsis-3 (58.8%) definitions, MR-proADM cut-offs on the day of sepsis diagnosis, day 1 and day 4, could provide the most accurate estimation of disease severity compared to all other biomarkers and clinical scores tested.

Patients with concentrations which were continually elevated over the first 24 hours were most likely to experience a failure in subsequent treatment with a significantly elevated risk of mortality.

The goal of ICU treated should be to either maintain or decrease MR-proADM concentrations to within the low severity concentration range as quickly as possible to prevent any further disease progression, treatment failure or mortality risk.

 

Figure 1. MR-proADM cut-offs to identify low, intermediate and high sepsis severity in the ICU upon sepsis diagnosis and after day 1 and day 4.

 

Equivalent cut-offs for MR-proADM, SOFA and lactate can be seen below in Table 1, with corresponding 28 day mortality rates.

   

Sepsis diagnosis

Day 1

Day 4

 

Disease severity level

Cut-off

Mortality rate

Cut-off

Mortality rate

Cut-off

Mortality rate

MR-proADM
(nmol/L)

Low

2.75

9.8%

2.75

7.9%

2.25

5.5%

High

10.9

55.9%

9.5

53.7%

7.70

48.3%

SOFA
(points)

Low

7

13.8%

8

11.3%

5.5

7.0%

High

14

41.3%

14

52.7%

13

48.9%

Lactate
(mmol/L)

Low

1.4

15.8%

1.22

10.6%

0.89

12.1%

High

6.4

52.5%

3.5

58.9%

2.15

48.8%

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