Quantitative indices of dynamics in concentrations of lipopolysaccharide-binding protein (LBP) as prognostic factors in severe sepsis/septic shock patients--comparison with CRP and procalcitonin.

OBJECTIVES

To devise and evaluate quantitative indices of dynamics in lipopolysaccharide-binding protein (LBP), CRP, and procalcitonin concentrations as prognostic markers in sepsis.

DESIGN AND METHODS

Prospective observational cross-sectional study with 5-day follow-up. Simple (Δ(5-1)) and relative (chain indices-based) rates for LBP (ELISA), procalcitonin (immunoluminometry), and CRP were devised.

RESULTS

Admission concentrations of all markers were higher in septic patients than controls. Not the admission levels but markers' time-courses differed between survivors (declining) and non-survivors (persistently high). Simple and relative rates were greater in survivors than non-survivors. Their accuracies as outcome predictors were comparable, higher for LBP and CRP than PCT. At ~95% sensitivity, the highest specificity had LBP relative and simple rates. Except for sepsis severity scores, only LBP was independently associated with lethal outcome.

CONCLUSIONS

For outcome prediction, the evaluation of dynamics of sepsis mediators, expressed by simple or relative rates, is a more suitable alternative to markers' peak values.