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30.06.2018 | Original | Ausgabe 7/2018

Intensive Care Medicine 7/2018

Circulating biomarkers may be unable to detect infection at the early phase of sepsis in ICU patients: the CAPTAIN prospective multicenter cohort study

Zeitschrift:
Intensive Care Medicine > Ausgabe 7/2018
Autoren:
Marianna Parlato, François Philippart, Alexandra Rouquette, Virginie Moucadel, Virginie Puchois, Sophie Blein, Jean-Pierre Bedos, Jean-Luc Diehl, Olfa Hamzaoui, Djillali Annane, Didier Journois, Myriam Ben Boutieb, Laurent Estève, Catherine Fitting, Jean-Marc Treluyer, Alexandre Pachot, Minou Adib-Conquy, Jean-Marc Cavaillon, Benoît Misset, The Captain Study Group
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00134-018-5228-3) contains supplementary material, which is available to authorized users.
The results of this paper were presented in part at the annual congress of the European Shock Society in September 2017 in Paris, France, and accepted for presentation at the annual congress of the French Society for Intensive Care in January 2018 in Paris, France.
Marianna Parlato and François Philippart are first co-authors.
The members of the CAPTAIN study team are provided in the Acknowledgements section.
Minou Adib-Conquy: Deceased.

Abstract

Purpose

Sepsis and non-septic systemic inflammatory response syndrome (SIRS) are the same syndromes, differing by their cause, sepsis being secondary to microbial infection. Microbiological tests are not enough to detect infection early. While more than 50 biomarkers have been proposed to detect infection, none have been repeatedly validated.

Aim

To assess the accuracy of circulating biomarkers to discriminate between sepsis and non-septic SIRS.

Methods

The CAPTAIN study was a prospective observational multicenter cohort of 279 ICU patients with hypo- or hyperthermia and criteria of SIRS, included at the time the attending physician considered antimicrobial therapy. Investigators collected blood at inclusion to measure 29 plasma compounds and ten whole blood RNAs, and—for those patients included within working hours—14 leukocyte surface markers. Patients were classified as having sepsis or non-septic SIRS blindly to the biomarkers results. We used the LASSO method as the technique of multivariate analysis, because of the large number of biomarkers.

Results

During the study period, 363 patients with SIRS were screened, 84 having exclusion criteria. Ninety-one patients were classified as having non-septic SIRS and 188 as having sepsis. Eight biomarkers had an area under the receiver operating curve (ROC-AUC) over 0.6 with a 95% confidence interval over 0.5. LASSO regression identified CRP and HLA-DRA mRNA as being repeatedly associated with sepsis, and no model performed better than CRP alone (ROC-AUC 0.76 [0.68–0.84]).

Conclusions

The circulating biomarkers tested were found to discriminate poorly between sepsis and non-septic SIRS, and no combination performed better than CRP alone.

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