title: Multi-marker approach using procalcitonin, presepsin, galectin-3, and soluble suppression of tumorigenicity 2 for the prediction of mortality in sepsis.
abstract: BACKGROUND
  Biomarker could be objective and reliable tools to predict mortality in sepsis. We explored the prognostic utilities of emerging biomarkers in septic patients and questioned whether adding biomarkers to the clinical variables would improve the prediction of mortality in sepsis.
  
  
  METHODS
  This retrospective study included 157 septic patients (112 patients with sepsis; 45 patients with septic shock). Procalcitonin (PCT), presepsin, galectin-3, and soluble suppression of tumorigenicity 2 (sST2) concentrations were analyzed in relation to the 30-day all-cause mortality. Their value added on top of Sequential (Sepsis-related) Organ Failure Assessment (SOFA) score, high-sensitivity C-reactive protein, and white blood cells was also analyzed.
  
  
  RESULTS
  PCT could not predict 30-day mortality. Univariate hazard ratio [HR with 95% confidence interval (CI)] of the other dichotomized variables was: 1.33 (0.55-3.194) for presepsin; 7.87 (2.29-26.96) for galectin-3; 1.55 (0.71-3.38) for sST2; and 2.18 (1.01-4.75) for SOFA score. The risk of 30-day mortality increased stepwise as the number of biomarkers above optimal cutoff values increased, and the highest risk was observed when all four biomarkers and SOFA score increased (HR = 14.5). Multi-marker approach predicted 30-day mortality better than SOFA score [area under the curves (95% CI), 0.769 (0.695-0.833) vs. 0.615 (0.535-0.692)]. In reclassification analyses, adding biomarkers to clinical variables improved the prediction of mortality.
  
  
  CONCLUSIONS
  This study demonstrated a possible prognostic utility of PCT, presepsin, galectin-3, and sST2 in sepsis. Multi-marker approach could be beneficial for an optimized management of patients with sepsis.
authors.affiliation: Department of Laboratory Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1, Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 05030, Korea.
authors.forename: Hanah
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1, Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 05030, Korea. dearmina@hanmail.net.
authors.forename: Mina
authors.identifier: http://orcid.org/0000-0002-4429-9978
authors.initials: M
authors.lastname: Hur
authors.affiliation: Department of Laboratory Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1, Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 05030, Korea.
authors.forename: Hee-Won
authors.initials: HW
authors.lastname: Moon
authors.affiliation: Department of Laboratory Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1, Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 05030, Korea.
authors.forename: Yeo-Min
authors.initials: YM
authors.lastname: Yun
authors.affiliation: Departments of Medical-Surgery Sciences and Translational Medicine, School of Medicine and Psychology, Sant' Andrea Hospital, 'Sapienza' University, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Somma
keywords: Galectin-3; Presepsin; Procalcitonin; Prognosis; Sepsis; sST2