title: Risk assessment in sepsis: a new prognostication rule by APACHE II score and serum soluble urokinase plasminogen activator receptor.
abstract: BACKGROUND
  Early risk assessment is the mainstay of management of patients with sepsis. APACHE II is the gold standard prognostic stratification system. A prediction rule that aimed to improve prognostication by APACHE II with the application of serum suPAR (soluble urokinase plasminogen activator receptor) is developed.
  
  
  METHODS
  A prospective study cohort enrolled 1914 patients with sepsis including 62.2% with sepsis and 37.8% with severe sepsis/septic shock. Serum suPAR was measured in samples drawn after diagnosis by an enzyme-immunoabsorbent assay; in 367 patients sequential measurements were performed. After ROC analysis and multivariate logistic regression analysis a prediction rule for risk was developed. The rule was validated in a double-blind fashion by an independent confirmation cohort of 196 sepsis patients, predominantly severe sepsis/septic shock patients, from Sweden.
  
  
  RESULTS
  Serum suPAR remained stable within survivors and non-survivors for 10 days. Regression analysis showed that APACHE II ≥ 17 and suPAR ≥ 12 ng/ml were independently associated with unfavorable outcome. Four strata of risk were identified: i) APACHE II <17 and suPAR <12 ng/ml with mortality 5.5%; ii) APACHE II < 17 and suPAR ≥ 12 ng/ml with mortality 17.4%; iii) APACHE II ≥ 17 and suPAR <12 ng/ml with mortality 37.4%; and iv) APACHE II ≥ 17 and suPAR ≥ 12 ng/ml with mortality 51.7%. This prediction rule was confirmed by the Swedish cohort.
  
  
  CONCLUSIONS
  A novel prediction rule with four levels of risk in sepsis based on APACHE II score and serum suPAR is proposed. Prognostication by this rule is confirmed by an independent cohort.
authors.forename: Evangelos J
authors.initials: EJ
authors.lastname: Giamarellos-Bourboulis
authors.forename: Anna
authors.initials: A
authors.lastname: Norrby-Teglund
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Mylona
authors.forename: Athina
authors.initials: A
authors.lastname: Savva
authors.forename: Iraklis
authors.initials: I
authors.lastname: Tsangaris
authors.forename: Ioanna
authors.initials: I
authors.lastname: Dimopoulou
authors.forename: Maria
authors.initials: M
authors.lastname: Mouktaroudi
authors.forename: Maria
authors.initials: M
authors.lastname: Raftogiannis
authors.forename: Marianna
authors.initials: M
authors.lastname: Georgitsi
authors.forename: Anna
authors.initials: A
authors.lastname: Linnér
authors.forename: George
authors.initials: G
authors.lastname: Adamis
authors.forename: Anastasia
authors.initials: A
authors.lastname: Antonopoulou
authors.forename: Efterpi
authors.initials: E
authors.lastname: Apostolidou
authors.forename: Michael
authors.initials: M
authors.lastname: Chrisofos
authors.forename: Chrisostomos
authors.initials: C
authors.lastname: Katsenos
authors.forename: Ioannis
authors.initials: I
authors.lastname: Koutelidakis
authors.forename: Katerina
authors.initials: K
authors.lastname: Kotzampassi
authors.forename: George
authors.initials: G
authors.lastname: Koratzanis
authors.forename: Marina
authors.initials: M
authors.lastname: Koupetori
authors.forename: Ioannis
authors.initials: I
authors.lastname: Kritselis
authors.forename: Korina
authors.initials: K
authors.lastname: Lymberopoulou
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Mandragos
authors.forename: Androniki
authors.initials: A
authors.lastname: Marioli
authors.forename: Jonas
authors.initials: J
authors.lastname: Sundén-Cullberg
authors.forename: Anna
authors.initials: A
authors.lastname: Mega
authors.forename: Athanassios
authors.initials: A
authors.lastname: Prekates
authors.forename: Christina
authors.initials: C
authors.lastname: Routsi
authors.forename: Charalambos
authors.initials: C
authors.lastname: Gogos
authors.forename: Carl-Johan
authors.initials: CJ
authors.lastname: Treutiger
authors.forename: Apostolos
authors.initials: A
authors.lastname: Armaganidis
authors.forename: George
authors.initials: G
authors.lastname: Dimopoulos
mesh_terms: D018806:APACHE; D015415:Biomarkers / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D055293:Receptors, Urokinase Plasminogen Activator / Q000097:blood*; D012044:Regression Analysis; D018570:Risk Assessment / Q000379:methods*; D018805:Sepsis / Q000175:diagnosis* / Q000401:mortality*; D012772:Shock, Septic / Q000175:diagnosis / Q000401:mortality; D013548:Sweden / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D055293:Receptors, Urokinase Plasminogen Activator