The Risk of Mortality and Organ Failure

The key mediator in sepsis

MR-proADM has a significantly higher accuracy, sensitivity and specificity in predicting the risk of mortality and organ failure in infectious adult and pediatric patients, compared to the use of either Procalcitonin or CRP. This makes MR-proADM ideal for use in the risk assessment of infectious patients, and especially well suited in the combination with a more accurate diagnostic biomarker, such as Procalcitonin.

 

Enhanced sensitivity and specificity

The availability of accurate tools to rapidly assess the risk of critically ill children on admission, or during the first 24 hours, to the Pediatric Intensive Care Unit (PICU) is of critical importance34. Commonly used tools include the Pediatric Risk of Mortality (PRISM III), the Pediatric Index of Mortality (PIM 2)35-39 and the Pediatric Logistic Organ Dysfunction (PELOD) scores, however, whilst these tools can be useful in predicting the evolution of a wide group of patients, their utility with regards to individual patients appears to be limited40, complex to determine41, and more suited to an audit and research environment rather than in clinical decision making36, 38, 39.

The availability of a rapid and accurate biomarker test, therefore, to provide similar or improved risk assessment values, can greatly aid clinical decision making and earlier treatment intervention. A study by Rey et al. (2013)34 separated 254 pediatric admissions into mortality risk and organ failure groups, and found that CRP, PCT and MR-proADM values were increased in patients with a higher mortality risk, and in those with more than one organ failure. However, MR-proADM clearly had greater sensitivity, specificity and for both mortality risk and organ failure.

mr-proadm-organ-failure-auc-valuesSensitivity and specificity values of MR-proADM, PCT and CRP in PICU mortality risk and organ failure groups

 

Enhanced mortality and organ failure predictions

An analysis of AUC values for risk mortality scores and organ failures show extremely high values for MR-proADM (overall AUCs of 0.866 and 0.922 respectively). This is also the case for risk mortality scores in the presence of an infection (AUC of 0.869), and organ failure scores in both the presence and absence of an infection (AUCs of 0.943 and 0.901 respectively). Accordingly, this highlights strength of MR-proADM in both predicting the risk of developing organ failure and mortality in pediatrics.

mr-proadm-organ-failure-sensitivityAUC values for MR-proADM, PCT and CRP for risk mortality groups (total sample and with an infection) and organ failure groups (total sample, with and without an infection)

 

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