Soluble membrane receptors, interleukin 6, procalcitonin and C reactive protein as prognostic markers in patients with severe sepsis and septic shock

Juan-Jesús Ríos-Toro, Mercedes Márquez-Coello, José-María García-Álvarez, Andrés Martín-Aspas, Ricardo Rivera-Fernández, Ana Sáez de Benito, José-Antonio Girón-González, Juan-Jesús Ríos-Toro, Mercedes Márquez-Coello, José-María García-Álvarez, Andrés Martín-Aspas, Ricardo Rivera-Fernández, Ana Sáez de Benito, José-Antonio Girón-González

Abstract

Background: The objective of this study was to explore the diagnostic and prognostic value of soluble triggering receptor expressed on myeloid cell 1 (sTREM-1), soluble cluster of differentiation 14 (sCD14), soluble cluster of differentiation 163 (sCD163), interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) serum levels for patients with severe sepsis and septic shock in an intensive care unit (ICU).

Methods: Fifty patients admitted at the ICU with the diagnosis of severe sepsis or septic shock were studied. SOFA and APACHE II scores as well as serum biomarkers were measured at days 0, 2 and 5. The influence of these variables on 28-day mortality was analyzed. Twenty healthy individuals served as controls.

Results: Baseline serum concentrations of sTREM-1, sCD163, IL-6 and PCT correlated with SOFA score. Only sTREM-1 levels correlated with APACHE II score. The 28-day mortality rate for all patients was 42%. The absence of risk factors for infection, presence of septic shock, baseline values of sCD14 and decrease of PCT and IL-6 from baseline to day 5 were variables associated to mortality in the univariate analysis. The unique independent factor associated to mortality in the multivariate analysis was a decrease of PCT higher than 50% from days 0 to 5.

Conclusions: Serum levels of sTREM-1 are correlated with the severity of sepsis. A 50% decrease of PCT was the unique variable associated with survival in the multivariate analysis.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
Changes of SOFA (A) and APACHE II (B) scores of patients with severe sepsis/septic shock during the first 7 days of ICU stay. Patients are classified in two groups: survivors and non-survivors. Data are shown as mean (95% confidence interval). Survivors shown significant decreases of SOFA and APACHE II scores from day 0 to the followed days (*, p

Fig 2

Changes of serum concentrations of…

Fig 2

Changes of serum concentrations of sTREM-1 (A), sCD14 (B), sCD163 (C), IL-6 (D),…

Fig 2
Changes of serum concentrations of sTREM-1 (A), sCD14 (B), sCD163 (C), IL-6 (D), procalcitonin (E) and C reactive protein (F) of patients with severe sepsis/septic shock during the first 5 days of ICU stay. Patients are classified in two groups: survivors and non-survivors. Data are shown as mean (95% confidence interval). Significant differences in sTREM-1, IL-6, procalcitonin and C reactive protein from day 0 to day 5 of ICU stay were detected in survivors.

Fig 3

Receiver operating characteristics (ROC) curves…

Fig 3

Receiver operating characteristics (ROC) curves used to discriminate survivors compared to non-survivors with…

Fig 3
Receiver operating characteristics (ROC) curves used to discriminate survivors compared to non-survivors with severe sepsis/septic shock based on percentage of change in serum levels of IL-6 (A) and procalcitonin (B) from day 0 to day 5 of ICU stay.

Fig 4. Kaplan Meier curves of survival…

Fig 4. Kaplan Meier curves of survival of patients with severe sepsis/septic shock classified in…

Fig 4. Kaplan Meier curves of survival of patients with severe sepsis/septic shock classified in function of a decrease of procalcitonin levels higher (continuous line) or lower (dashed line) than 50% from day 0 to 5 of ICU stay.
A significant difference was detected among both groups of patients.
Fig 2
Fig 2
Changes of serum concentrations of sTREM-1 (A), sCD14 (B), sCD163 (C), IL-6 (D), procalcitonin (E) and C reactive protein (F) of patients with severe sepsis/septic shock during the first 5 days of ICU stay. Patients are classified in two groups: survivors and non-survivors. Data are shown as mean (95% confidence interval). Significant differences in sTREM-1, IL-6, procalcitonin and C reactive protein from day 0 to day 5 of ICU stay were detected in survivors.
Fig 3
Fig 3
Receiver operating characteristics (ROC) curves used to discriminate survivors compared to non-survivors with severe sepsis/septic shock based on percentage of change in serum levels of IL-6 (A) and procalcitonin (B) from day 0 to day 5 of ICU stay.
Fig 4. Kaplan Meier curves of survival…
Fig 4. Kaplan Meier curves of survival of patients with severe sepsis/septic shock classified in function of a decrease of procalcitonin levels higher (continuous line) or lower (dashed line) than 50% from day 0 to 5 of ICU stay.
A significant difference was detected among both groups of patients.

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