A predicative 30-day sepsis mortality score (SMS) based on multiple serum biomarkers added significant prognostic information and can be a valuable supplement to the standard Sequential Organ Failure Assessment (SOFA) score, according to a study published in the Journal of Critical Care.
Despite optimal care, sepsis continues to have a high mortality rate. The use of serum biomarkers has improved diagnoses, and it was hypothesized that using multiple markers will better reflect the complex physiology of sepsis.
From July 2011 to June 2014, 159 patients were evaluated in the intensive care unit of a major tertiary hospital in Pahang, Malaysia.
On presentation at the intensive care unit, relevant demographic information, initial SOFA score, comorbidities as assessed by the Charlson Comorbidity Index, primary sites of infection, and presence of bacteremia were noted and 10 mL whole blood was collected before antibiotic treatment.
Five markers were then tested: leukocyte count, procalcitonin, interleukin 6, and the paraoxonase (PON) and arylesterase activities of the enzyme PON-1. A logistical regression approach was used to develop the SMS, and the area under the receiver operating curve was calculated to compare predictive ability.
The area under the receiver operating curve of the SMS was higher than that of SOFA, at 0.814 (95% CI, 0.736-0.892) vs 0.767 (95% CI, 0.677-0.857); however, this was not statistically significant (P =.377). The 2 scores combined performed better than SOFA alone, 0.845 (95% CI, 0.777-0.899), and this increase was significant (P =.022).
Although the new SMS performed well, but not significantly better than SOFA, it was shown to be a valuable supplemental method. Further research, however, is needed to validate these results and determine whether the approach can be integrated into physician’s clinical practice.
Shukeri WFWM, Ralib AM, Abdulah NZ, Mat-Nor MB. Sepsis mortality score for the prediction of mortality in septic patients. J Crit Care. 2017;43:163-168.