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.
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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.
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