title: A simple bioscore improves diagnostic accuracy of sepsis after surgery.
abstract: BACKGROUND
  Rapid and accurate prediction for sepsis remains a challenge in surgical intensive care units. Detection of individual biomarkers is often of marginal usefulness, and several biomarkers are difficult to measure in the clinical setting. The aim of this study was to evaluate the diagnostic and prognostic performance of three routine biomarkers, procalcitonin (PCT), B-type natriuretic peptide (BNP), and lymphocyte percentage, as individual or in combination for sepsis in surgical critically ill patients.
  
  
  METHODS
  Circulating PCT, BNP, and lymphocyte percentage were measured in surgical patients on admission to the intensive care unit. A bioscore system combining these biomarkers was constructed. All studied variables were analyzed according to the diagnosis and clinical outcomes of sepsis.
  
  
  RESULTS
  A total of 320 consecutive patients were included in the analysis. One hundred fifty-six patients presented with sepsis. In the patients with sepsis, levels of PCT and BNP increased and lymphocyte percentage decreased. For individual biomarkers, PCT achieved the best area under the curve for the diagnosis of sepsis, whereas the diagnostic performance of the bioscore was better than that of each individual biomarker (area under the curve, 0.914 [95% confidence interval, 0.862-0.951]). Levels of BNP and bioscore increased in nonsurvivors in the entire cohort, but the accuracy of these two variables for mortality prediction was lower than that shown by Acute Physiology and Chronic Health Evaluation II score. Furthermore, bioscore failed to predict outcomes in septic patients.
  
  
  CONCLUSIONS
  A simple bioscore combining PCT together with BNP and lymphocyte percentage improves the diagnostic accuracy for sepsis in surgical critically ill patients but fails to predict outcomes in surgical patients with sepsis.
authors.affiliation: Surgical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Zimeng
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Surgical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Juan
authors.initials: J
authors.lastname: Chen
authors.affiliation: Surgical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Surgical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Si
authors.affiliation: Surgical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Zhiyi
authors.initials: Z
authors.lastname: Jiang
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China. Electronic address: sumsxyz@163.com.
authors.forename: Xuyu
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Surgical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China. Electronic address: carlg@163.net.
authors.forename: Xiangdong
authors.initials: X
authors.lastname: Guan
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D016638:Critical Illness; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D018805:Sepsis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D020097:Natriuretic Peptide, Brain; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide
keywords: B-type natriuretic peptide; Diagnostic biomarkers; Lymphocyte; Procalcitonin; Prognostic biomarkers; Sepsis; Surgery