title: Biomarkers (Procalcitonin, C Reactive Protein, and Lactate) as Predictors of Mortality in Surgical Patients with Complicated Intra-Abdominal Infection.
abstract: BACKGROUND
  An accurate and readily available biomarker for identifying patients with complicated intra-abdominal infection needing special attention in critical care units because of their greater risk of dying would be of value for intensivists.
  
  
  METHODS
  A multi-center, observational, retrospective study explored blood lactate, C-reactive protein (CRP), and procalcitonin (PCT) concentrations, and also Sequential Organ Failure Assessment (SOFA) and Simplified Acute Physiology Score (SAPS II) as mortality predictors in all adult patients with complicated intra-abdominal infection (cIAI) admitted to Surgical Critical Care Units (SCCUs) for ≥48 h in four Spanish hospitals (June 2012-June 2013). Logistic regression models (step-wise procedure) were constructed using as dependent variables "intra-SCCU mortality" or "overall mortality," and variables showing differences (p≤0.1) in bivariate analyses as independent variables.
  
  
  RESULTS
  One hundred twenty-one cases were included. Mortality intra-SCCU (R(2)=0.189, p=0.001) was associated with SAPS II (categorized as high if ≥47) (OR=9.55; 95% CI, 1.09-83.85; p=0.042) and 24 h-lactate (≥5.87 categorized as high) (OR=6.90; 95% CI, 1.28-37.08). Overall mortality (R(2)=0.275, p=0.001) was associated with peak PCT (≥100 categorized as high) (OR=11.28; 95% CI, 1.80-70.20), peak lactate (≥1.8 categorized as high) (OR=8.86; 95% CI, 1.51-52.10) and SOFA at admission (≥7 categorized as high) (OR=8.14; 95% CI, 1.69-39.20), but was predicted better (R(2)=0.275, p=0.001) by a single dummy variable (high peak PCT-high peak lactate concentrations) (OR=99.11; 95% CI, 5.21-1885.97; p=0.002).
  
  
  CONCLUSIONS
  In the present study, SAPS II and 24 h-lactate concentrations predicted intra-SCCU mortality whereas overall mortality was predicted better by concurrent high PCT and lactate peak concentrations than by clinical scores or by each biomarker separately.
authors.affiliation: 1Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Suarez-de-la-Rica
authors.affiliation: 1Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Maseda
authors.affiliation: 1Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Víctor
authors.initials: V
authors.lastname: Anillo
authors.affiliation: 2Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario, Valladolid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Tamayo
authors.affiliation: 3Anesthesiology and Surgical Critical Care Department, Hospital del Mar, Barcelona, Spain.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: García-Bernedo
authors.affiliation: 4Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Princesa, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Ramasco
authors.affiliation: 1Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Hernández-Gancedo
authors.affiliation: 1Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Araceli
authors.initials: A
authors.lastname: López-Tofiño
authors.affiliation: 5PRISM-AG, Madrid, Spain.
authors.forename: Maria-Jose
authors.initials: MJ
authors.lastname: Gimenez
authors.affiliation: 6Preventive Medicine Department, Hospital Infanta Cristina, Parla, Madrid, Spain.
authors.forename: Juan-Jose
authors.initials: JJ
authors.lastname: Granizo
authors.affiliation: 5PRISM-AG, Madrid, Spain.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Aguilar
authors.affiliation: 1Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Gilsanz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D016638:Critical Illness; D005260:Female; D006801:Humans; D059413:Intraabdominal Infections / Q000401:mortality* / Q000473:pathology*; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D019344:Lactic Acid; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide