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. 2024 Sep 6;14(17):1973.
doi: 10.3390/diagnostics14171973.

Predicting Mortality in Sepsis: The Role of Dynamic Biomarker Changes and Clinical Scores-A Retrospective Cohort Study

Norberth-Istvan Varga  1   2 , Adela-Teodora Benea  1   2 , Madalina-Ianca Suba  1   2 , Adrian Vasile Bota  3 , Cecilia Roberta Avram  4 , Casiana Boru  5 , Tiberiu Liviu Dragomir  6 , Mirandolina Prisca  7 , Tanasescu Sonia  8 , Monica Susan  9 , Florin George Horhat  10
Affiliations

Predicting Mortality in Sepsis: The Role of Dynamic Biomarker Changes and Clinical Scores-A Retrospective Cohort Study

Norberth-Istvan Varga et al. Diagnostics (Basel). .

Abstract

Background: The prognostic value of baseline inflammatory markers in sepsis remains controversial, with conflicting evidence regarding their association with mortality. The dynamic changes in these markers over time might offer additional insights into disease progression and patient outcomes.

Methods: This retrospective observational study included 138 patients with severe infections. The inflammatory biomarkers procalcitonin (PCT), C-reactive protein (CRP), and lactate (LAC) were measured at three time points: upon hospital admission (baseline), approximately 24-48 h after admission (second measurement; M2), and 48-72 h after admission (third measurement; M3). The primary outcome was 30-day mortality. A Mann-Whitney U test was used to compare the biomarker levels between the survivors and non-survivors. A Spearman's correlation was used to assess the relationships between the baseline parameters. A logistic regression and a receiver operating characteristic (ROC) curve analysis were employed to evaluate the prognostic value of the baseline markers and their dynamic changes.

Results: The baseline LAC and SOFA score were significantly associated with 30-day mortality. The percentage decrease in PCT, CRP, and LAC from the baseline to M3 emerged as strong predictors of survival, with the ROC curve analysis demonstrating superior discriminatory ability compared to the baseline values. CRP_Delta exhibited the highest AUC (0.903), followed by PCT_Delta (0.843) and LAC_Delta (0.703).

Conclusions: The dynamic changes in these inflammatory biomarkers, particularly PCT, CRP, and LAC, offer valuable prognostic information beyond their baseline levels in predicting 30-day mortality in severe infections. These findings highlight the importance of monitoring biomarker trends for early risk stratification and potential treatment guidance.

Keywords: CRP; biomarkers; lactate; procalcitonin; prognosis; sepsis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
ROC curves of the baseline variables and their corresponding percentage of change within the 72 h timeframe (third measurement).
See this image and copyright information in PMC

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