1Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands. 2Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands. 3Thermo Fisher Scientific/B.R.A.H.M.S. GmbH, Hennigsdorf, Germany. 4Department of Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Crit Care Med. 2015 Feb;43(2):373-81. doi: 10.1097/CCM.0000000000000709.
Risk assessment in ICU patients using commonly used prognostic models may be influenced using different data definitions and by errors in data collection. We investigated whether a set of biomarkers (procalcitonin, MR-pro-adrenomedullin, CT-pro-endothelin-1, CT-pro-arginine vasopressin, and MR-pro-atrial natriuretic peptide), alone or as a panel, could be useful in postoperative risk assessment for hospital mortality in comparison with the Acute Physiology and Chronic Health Evaluation IV score.
In a prospective observational cohort study, we analyzed 800 consecutive patients undergoing elective cardiac surgery. We assessed biomarker levels on admission to the ICU and every 6 hours thereafter for 24 hours. For every postoperative time point and for every biomarker, we determined the predictive value for hospital mortality and made a comparison with the Acute Physiology and Chronic Health Evaluation IV score.
Intensive care of an academic referral hospital.
A total of 800 consecutive patients undergoing elective cardiac surgery.
None.
MR-pro-adrenomedullin is a good predictor of mortality (c-statistic at time point 6 hr after admission to the ICU, 0.940; 95% CI, 0.918-0.956) and performed better than the Acute Physiology and Chronic Health Evaluation IV score (c-statistic, 0.842; 95% CI, 0.811-0.868). The c-statistic did not change significantly on the time points 6, 12, and 18 hours after admission. Using a cutoff value for proadrenomedullin taken 6 hours after admission on ICU (time point 2) of 3.2 nmol/L sensitivity was 81.8% and specificity 93.9%, the positive likelihood ratio was 13.3, positive predictive value was 31.0%, and negative predictive value was 99.4%. Patients with a MR-pro-adrenomedullin above this cutoff level had an odds ratio of 68.9 (95% CI, 22.2-213.1) for not surviving their hospital stay. The other biomarkers had less predictive power.
In elective cardiac surgery, MR-pro-adrenomedullin measured between 6 and 18 hours after admission to the ICU is a better predictor of hospital mortality in comparison with the Acute Physiology and Chronic Health Evaluation IV score.
使用常用预后模型对 ICU 患者进行风险评估可能会受到不同数据定义和数据收集错误的影响。我们研究了一组生物标志物（降钙素原、MR-pro-肾上腺髓质素、CT-pro-内皮素-1、CT-pro-精氨酸加压素和 MR-pro-心房利钠肽），单独或作为一个组合，与急性生理学和慢性健康评估 IV 评分相比，是否可用于术后评估医院死亡率。
在一项前瞻性观察队列研究中，我们分析了 800 例连续接受择期心脏手术的患者。我们在 ICU 入院时以及此后每 6 小时评估一次生物标志物水平，持续 24 小时。对于每个术后时间点和每个生物标志物，我们确定了其对医院死亡率的预测价值，并与急性生理学和慢性健康评估 IV 评分进行了比较。
学术转诊医院的重症监护病房。
连续 800 例接受择期心脏手术的患者。
无。
MR-pro-肾上腺髓质素是死亡率的良好预测指标（ICU 入院后 6 小时的时间点的 C 统计量为 0.940；95%CI，0.918-0.956），并且优于急性生理学和慢性健康评估 IV 评分（C 统计量为 0.842；95%CI，0.811-0.868）。入院后 6、12 和 18 小时的时间点，C 统计量无显著变化。在 ICU 入院后 6 小时（时间点 2）使用 proadrenomedullin 的截断值为 3.2 nmol/L，灵敏度为 81.8%，特异性为 93.9%，阳性似然比为 13.3，阳性预测值为 31.0%，阴性预测值为 99.4%。MR-pro-肾上腺髓质素水平高于该截断值的患者，其住院期间未存活的优势比为 68.9（95%CI，22.2-213.1）。其他生物标志物的预测能力较低。
在择期心脏手术中，ICU 入院后 6 至 18 小时内测量的 MR-pro-肾上腺髓质素与急性生理学和慢性健康评估 IV 评分相比，是医院死亡率的更好预测指标。
