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Pancreatic Stone Protein Predicts Outcome in Patients With Peritonitis in the ICU*

Gukasjan, Raphael MD1; Raptis, Dimitri Aristotle MD MSc2; Schulz, Hans-Ulrich MD1; Halangk, Walter PhD1; Graf, Rolf PhD2

Erratum

In the article in the April 2013 issue, starting on page 1027, several of the SDC links incorrectly link to past Supplemental Digital Content.

On page 1030, the following paragraphs are updated:

Association of Blood Parameters With Clinical Conditions and Outcomes

Table 2 demonstrates the association of WBC, CRP, IL-6, PCT, and PSP with different clinical conditions, such as the severity and localization of peritonitis, the presence of organ failure, and mortality in the ICU. PSP was the only blood parameter that significantly differed among all clinical conditions and nearly all of their subgroups on univariate analysis (Table 2, Figs. 1–2; Table S3 and Fig. S5, Supplemental Digital Content 1, http://links.lww.com/CCM/A685). Furthermore, PSP and PCT were the only blood parameters with a predictive value for the need for renal replacement in the ICU (Fig. S2, Supplemental Digital Content 1, http://links.lww.com/CCM/A685).

Blood Parameter and Clinical Score Correlation

PSP best correlated with the clinical scores (MPI, APACHE II, and SOFA scores) when compared with WBC, CRP, IL-6, and PCT (Table S1 and Fig. S4, Supplemental Digital Content 1, http://links.lww.com/CCM/A685). Similarly, PSP was the only blood parameter that significantly differed among the clinical scores when grouped according the cut-off points generated by the ROC curves (Table S2 and Fig. S3, Supplemental Digital Content 1, http://links.lww.com/CCM/A685).

The fourth and sixth paragraph of the Blood Parameters and Clinical Score Prediction of Death in the ICU section on pages 1031 and 1032, respectively, should be:

Similarly, we assessed the clinical scores in predicting death in the ICU using ROC curve analysis. The SOFA score was superior to APACHE II or MPI score in predicting death in the ICU (Fig. S1, Supplemental Digital Content 1, http://links.lww.com/CCM/A685). Figure 4 further illustrates the 90-day survival of patients with a PSP < 130 vs. ≥ 130, being 96% and 74%, respectively (Cox regression hazard risk ratio: 6.48 [95% confidence interval, 1.45–28.97]; p = 0.015).

To further substantiate the potential of PSP as a predictive factor, we performed a multivariate stepwise regression analysis. Among all available blood parameters, PSP was the only independent predicting factor for death in the ICU (Table 4). Similarly, among the clinical scores, SOFA and APACHE II were independent predictive factors for death in the ICU (Table S4, Supplemental Digital Content 1, http://links.lww.com/CCM/A685).

Critical Care Medicine. 41(6):e104, June 2013.

doi: 10.1097/CCM.0b013e3182771193
Clinical Investigations

Objective: To determine the value of pancreatic stone protein in predicting sepsis-related postoperative complications and death in the ICU.

Design: A prospective cohort study of postoperative patients admitted to the ICU. Blood samples for analysis were taken within 3 hours from admission to the ICU including pancreatic stone protein, white blood cell counts, C-reactive protein, interleukin-6, and procalcitonin. The Mannheim Peritonitis Index and Acute Physiology and Chronic Health Evaluation II clinical scores were also determined. Univariate and multivariate analyses were performed to determine the diagnostic accuracy and independent predictors of death in the ICU [Clinicaltrials.gov, NCT01465711].

Setting: An adult medical–surgical ICU in a teaching hospital in Germany.

Patients: Ninety-one consecutive postoperative patients with proven diagnosis of secondary peritonitis admitted to the ICU were included in the study from August 17, 2007, to February 8, 2010.

Interventions: Peripheral vein blood sampling.

Measurements and Main Results: Univariate analysis demonstrated that pancreatic stone protein has the highest diagnostic accuracy for complications and is the best predictor for death in the ICU. Pancreatic stone protein had the highest overall efficacy in predicting death with an odds ratio of 4.0 vs. procalcitonin (odds ratio 3.2), interleukin-6 (odds ratio 2.8), C-reactive protein (odds ratio 1.3), and WBCs (odds ratio 1.4). By multivariate analysis, pancreatic stone protein was the only independent predictor of death.

Conclusions: In a population of patients with sepsis-related complications, serum-pancreatic stone protein levels demonstrate a high diagnostic accuracy to discriminate the severity of peritonitis and to predict death in the ICU. This test could be of value in the clinical diagnosis and therapeutic decision making in the ICU.

1 Department of Surgery, Division of Experimental Surgery, Otto-von-Guericke University, Magdeburg, Germany.

2 Department of Surgery, University Hospital Zurich, Switzerland.

*See also p. 1150.

Drs. Gukasjan, Raptis, Halangk, and Graf contributed to this work equally.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

The authors of this manuscript contributed in drafting the article, revising it, and final approval of the version to be published. The authors confirm that there is no one else who fulfills the criteria but has not been included as an author.

This study was supported, in part, by a grant from the Gebert-Rüf-Foundation, Basel, Switzerland.

Dr. Schulz received travel reimbursement of congress expenses from Astellas Inc. Dr. Halangk has a patent application for a method for assaying peritonitis in humans. Rolf Graf is the inventor of a patent owned by the University of Zurich for the use of “PSP/reg as a marker of sepsis”. Hans-Ulrich Schulz, Walter Halangk, and Rolf Graf have applied for a patent to be owned by the University of Magdeburg and the University of Zurich for the use of “PSP/reg as a marker of peritonitis”. The remaining authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: dimitri.raptis@usz.ch

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins