title: Role of tissue disorder markers in the evaluation of disease progress and outcome prediction: a prospective cohort study in non-cardiac critically ill patients.
abstract: BACKGROUND
  Acute Physiology and Chronic Health Evaluation (APACHE) has a remarkable association with clinical syndrome, life expectancy, and length of ward stay. But the defects are obvious. It is crucial to detect an effective and convenient evaluation method to monitor disease progress and predict outcome.
  
  
  OBJECTIVE
  To determine whether myoglobin (Mb) and other five tissue disorder biomarkers, troponin-I, creatine-kinase, creatine kinase-muscle brain, aspartate aminotransferase, and lactate dehydrogenase are independent predictors of disease progress and mortality in non-cardiac critical illness.
  
  
  METHODS
  A prospective study with 179 patients admitted to the Intensive Care Unit was conducted. All serum tissue disorder markers and APACHE-II score were measured within 24  hr of admission.
  
  
  RESULTS
  All the six biomarkers were significantly correlated with disease severity stratified by APACHE-II and outcome. Serial blood samples were taken from 17 patients on detection of two new organs failure. The occurrence of organs failure was significantly associated with the elevation of Mb, troponin-I, and APACHE-II. Multivariate analysis demonstrated that elevated Mb was the principal risk factor related to mortality either during hospitalization or 180-day followup. Kaplan-Meier method and log-rank test also showed that patients with elevated Mb levels had significantly shorter survival. The mortality was higher in patients with both Mb>500  ng/ml and APACHE-II>20 than in those with only Mb>500  ng/ml or APACHE-II>20.
  
  
  CONCLUSIONS
  All the six tissue disorder markers are predictors of disease severity, organ failure, and outcome in non-cardiac critically illness. Among them, Mb plays a pivotable role. The combined use of Mb and APACHE-II suggest an effective method to determine the outcome of critical ill syndrome.
authors.affiliation: Emergency Department, Shanghai Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Ye
authors.forename: Zi
authors.initials: Z
authors.lastname: Chen
authors.forename: Tingsong
authors.initials: T
authors.lastname: Wang
authors.forename: Jianjing
authors.initials: J
authors.lastname: Tong
authors.forename: Xiaoguang
authors.initials: X
authors.lastname: Li
authors.forename: Jie
authors.initials: J
authors.lastname: Jiang
authors.forename: Erzhen
authors.initials: E
authors.lastname: Chen
authors.forename: Yiming
authors.initials: Y
authors.lastname: Lu
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D015331:Cohort Studies; D018450:Disease Progression; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D009211:Myoglobin / Q000097:blood*; D011379:Prognosis; D016019:Survival Analysis; D019210:Troponin I / Q000097:blood; D055815:Young Adult
chemical_list: D015415:Biomarkers; D009211:Myoglobin; D019210:Troponin I