title: Elevated pregnancy-associated plasma protein A predicts myocardial dysfunction and death in severe sepsis.
abstract: BACKGROUND
  Pregnancy-associated plasma protein A (PAPPA) is an emerging biomarker used in various medical fields but has yet to be evaluated in critical care medicine. This study evaluates the value of PAPPA as a biomarker in predicting myocardial dysfunction and 28-day mortality in patients with severe sepsis.
  
  
  METHODS
  Serum concentrations of PAPPA and traditional cardiac biomarkers including cardiac troponin I (cTnI) and B-type natriuretic peptide (BNP) were measured on admission in 118 severely septic patients. The value of PAPPA for the diagnosis of sepsis-related myocardial dysfunction (SRMD) and for the prediction of 28-day mortality was subsequently evaluated using statistical methods.
  
  
  RESULTS
  PAPPA was elevated (≥4.5 ng/mL) in 76 (64.4%) patients; patients with elevated PAPPA were more likely to have SRMD (76.3% vs. 38.1%, P < 0.001). By comparison of the area under the curve (AUC) in receiver operating characteristics analysis, PAPPA had comparable value (AUC 0.661, P = 0.003) to conventional biomarkers (BNP: AUC 0.699, P < 0.001; cTnI: AUC 0.647, P = 0.007) in the diagnosis of SRMD and offered superior value (AUC 0.771, P < 0.001) over them (all AUC<0.7, P > 0.05) in the prediction of 28-day death. Increased PAPPA (≥5.4 ng/mL) was associated with lower 28-day survival (χ(2) = 19.78, P < 0.001) and independently predicted 28-day mortality in septic patients.
  
  
  CONCLUSIONS
  Serum PAPPA concentration frequently increases in patients with severe sepsis and appears to be associated with SRMD. PAPPA can be used as a novel biomarker for the diagnosis of SRMD and the prediction of outcomes in critically ill patients.
authors.affiliation: Intensive Care Unit (ICU), Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China.
authors.forename: Zhaocai
authors.initials: Z
authors.lastname: Zhang
authors.forename: Haiwen
authors.initials: H
authors.lastname: Dai
authors.forename: Yihua
authors.initials: Y
authors.lastname: Yu
authors.forename: Jidong
authors.initials: J
authors.lastname: Yang
authors.forename: Jin
authors.initials: J
authors.lastname: Chen
authors.forename: Liang
authors.initials: L
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D009202:Cardiomyopathies / Q000097:blood* / Q000150:complications / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism*; D011379:Prognosis; D018805:Sepsis / Q000097:blood* / Q000150:complications / Q000401:mortality / Q000473:pathology
chemical_list: D015415:Biomarkers; D011266:Pregnancy-Associated Plasma Protein-A
keywords: Biomarker; myocardial dysfunction; pregnancy-associated plasma protein A; prognosis; sepsis