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Long Pentraxin 3 as a Predictive Marker of Mortality in Severe Septic Patients Who Received Successful Early Goal-Directed Therapy

Authors
 Sun Bean Kim  ;  Kyoung Hwa Lee  ;  Ji Un Lee  ;  Hea Won Ann  ;  Jin Young Ahn  ;  Yong Duk Jeon  ;  Jung Ho Kim  ;  Nam Su Ku  ;  Sang Hoon Han  ;  Jun Yong Choi  ;  Young Goo Song  ;  June Myung Kim 
Citation
 Yonsei Medical Journal, Vol.58(2) : 370-379, 2017 
Journal Title
 Yonsei Medical Journal 
ISSN
 0513-5796 
Issue Date
2017
MeSH
APACHE ; Aged ; Biomarkers/blood ; C-Reactive Protein/analysis* ; C-Reactive Protein/metabolism ; Calcitonin/blood ; Cause of Death ; Female ; Humans ; Leukocyte Count ; Male ; Middle Aged ; Neutrophils ; Organ Dysfunction Scores ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; ROC Curve ; Reference Standards ; Sensitivity and Specificity ; Sepsis/blood ; Sepsis/mortality* ; Serum Amyloid P-Component/analysis* ; Time Factors
Keywords
Pentraxin 3 ; early-goal directed therapy ; mortality ; predictive biomarker ; severe sepsis
Abstract
PURPOSE: Pentraxin 3 (PTX3) has been suggested to be a prognostic marker of mortality in severe sepsis. Currently, there are limited data on biomarkers including PTX3 that can be used to predict mortality in severe sepsis patients who have undergone successful initial resuscitation through early goal-directed therapy (EGDT). MATERIALS AND METHODS: A prospective cohort study was conducted among 83 severe sepsis patients with fulfillment of all EGDT components and the achievement of final goal. Plasma PTX3 levels were measured by sandwich ELISA on hospital day (HD) 0, 3, and 7. The data for procalcitonin, C-reactive protein and delta neutrophil index were collected by electric medical record. The primary outcome was 28-day all-cause mortality. RESULTS: 28-day all-cause mortality was 19.3% and the median (interquartile range) APHCH II score of total patients was 16 (13-19). The non-survivors (n=16) had significantly higher PTX3 level at HD 0 [201.4 (56.9-268.6) ng/mL vs. 36.5 (13.7-145.3) ng/mL, p=0.008]. PTX3 had largest AUC(ROC) value for the prediction of mortality among PTX3, procalcitonin, delta neutrophil index, CRP and APACHE II/SOFA sore at HD 0 [0.819, 95% confidence interval (CI) 0.677-0.961, p=0.008]. The most valid cut-off level of PTX3 at HD 0 was 140.28 ng/mL (sensitivity 66.7%, specificity 73.8%). The PTX3 and procalcitonin at HD 0 showed strong correlation (r=0.675, p<0.001). However, PTX3 at HD 0 was the only independent predictive marker in Cox's proportional hazards model (≥140 ng/mL; hazard rate 7.16, 95% CI 2.46-15.85, p=0.001). CONCLUSION: PTX3 at HD 0 could be a powerful predictive biomarker of 28-day all-cause mortality in severe septic patients who have undergone successful EGDT.
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DOI
10.3349/ymj.2017.58.2.370
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
구남수(Ku, Nam Su) ORCID logo https://orcid.org/0000-0002-9717-4327
김준명(Kim, June Myung)
송영구(Song, Young Goo) ORCID logo https://orcid.org/0000-0002-0733-4156
이경화(Lee, Kyoung Hwa) ORCID logo https://orcid.org/0000-0003-0033-1398
전용덕(Jeon, Yong Duk)
최준용(Choi, Jun Yong) ORCID logo https://orcid.org/0000-0002-2775-3315
한상훈(Han, Sang Hoon) ORCID logo https://orcid.org/0000-0002-4278-5198
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/154146
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