Mortality Odds, Clearance and Survival Stratification

The rapid identification and risk assessment of sepsis in the ICU

Increased odds of mortality after 7 days

Measurement of MR-proADM plasma levels on days 1, 3 and 7 in severe sepsis and septic shock patients, and analysis by univariate RLB, found that patients with significantly higher levels of MR-proADM on day 7 were up to 4 times more likely to die, with an odds ratio of 3.9816. CRP, Lactate and PCT were also concurrently measured and showed no significant differences between survivors and non-survivors.

mr-proadm-mortality-odds-ratioOdds ratio for mortality prediction of MR-proADM up to 7 days after ICU admission16

 

Increased MR-proADM clearance can predict survival

Decreased MR-proADM clearance by the kidneys may be, in part, responsible for the increased levels observed in sepsis18. Indeed, a significant correlation between MR-proADM and creatinine levels exists (r = 0.76; P < 0.001)10, although evidence also suggests that clearance from the lungs may play a role19, 20. Accordingly, increased levels of circulating MR-proADM can point towards a continued septic state, in terms of vasodilation and hypotension associated with septic shock21. Results have shown that MR-proADM clearance on the 5th day of ICU treatment of severe sepsis patients is significantly increased in survivors compared to non-survivors, whereas no significant differences can be found after only 48 hours17.

 

Clearance of MR-proADM up to 5 days after ICU admissionClearance of MR-proADM up to 5 days after ICU admission. Significant differences in percentage values can be found between survivors and non-survivors17

 

APACHE II score complexity and enhanced survival probability stratification

Existing sepsis outcome predictors, such as APACHE II, are helpful in identifying patients with a high risk of death who are more likely to benefit from interventional treatment. However, calculating clinical scores can be time consuming, sometimes complex, and can show a high inter-observer variability22, 23.

The APACHE II score was not originally proposed for use in outcome prediction in sepsis24, and several inherent limitations may result in misleading scores25. Furthermore, individual treatment decisions can be problematic because of the difficulties in determining the score clinically26, 27, nevertheless, it remains the most widely used score for the early recognition of patients at a high risk of death28.

The simplicity in determining MR-proADM values negate many of these issues, whilst retaining a significant degree of correlation with overall APACHE II scores, as well as with its quartiles12.

Furthermore, defined MR-proADM cut-off values to stratify survival rates on the 5th day in the ICU, for both MR-proADM concentrations and clearance percentages, show a clear separation of mortality, both in the ICU and at 90 days after onset of sepsis (p < 0.0001 and p = 0.005 respectively).

Thus, the importance of incorporating MR-proADM in the ICU to accurately and rapidly assess a patient’s risk of mortality cannot be overstated.

Kaplan-Meier survival curves for (A) the stratification of septic patient groupsKaplan-Meier survival curves for (A) the stratification of septic patient groups with MR-proADM levels greater or less than 2.5 nmol/L on the 5th day following admission to the ICU, and (B) the stratification of septic patient groups with MR-proADM clearance values greater or less than 30 % on the 5th day following admission to the ICU17

 

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