Impact assessment in a non-government organisation

<p>Supplemental_figure for A Simple Scoring System Using the Red Blood Cell Distribution Width, Delta Neutrophil Index, and Platelet Count to Predict Mortality in Patients With Severe Sepsis and Septic Shock by Yong Chan Kim, Je Eun Song, Eun Jin Kim, Heun Choi, Woo Yong Jeong, In Young Jung, Su Jin Jeong, Nam Su Ku, Jun Yong Choi, Young Goo Song, and June Myung Kim in Journal of Intensive Care Medicine</p

Supplemental_table_2 - A Simple Scoring System Using the Red Blood Cell Distribution Width, Delta Neutrophil Index, and Platelet Count to Predict Mortality in Patients With Severe Sepsis and Septic Shock

<p>Supplemental_table_2 for A Simple Scoring System Using the Red Blood Cell Distribution Width, Delta Neutrophil Index, and Platelet Count to Predict Mortality in Patients With Severe Sepsis and Septic Shock by Yong Chan Kim, Je Eun Song, Eun Jin Kim, Heun Choi, Woo Yong Jeong, In Young Jung, Su Jin Jeong, Nam Su Ku, Jun Yong Choi, Young Goo Song, and June Myung Kim in Journal of Intensive Care Medicine</p

The C-Reactive Protein/Albumin Ratio as an Independent Predictor of Mortality in Patients with Severe Sepsis or Septic Shock Treated with Early Goal-Directed Therapy

<div><p>Background</p><p>Sepsis, including severe sepsis and septic shock, is a major cause of morbidity and mortality. Albumin and C-reactive protein (CRP) are considered as good diagnostic markers for sepsis. Thus, initial CRP and albumin levels were combined to ascertain their value as an independent predictor of 180-day mortality in patients with severe sepsis and septic shock.</p><p>Materials and Methods</p><p>We conducted a retrospective cohort study involving 670 patients (>18 years old) who were admitted to the emergency department and who had received a standardized resuscitation algorithm (early goal-directed therapy) for severe sepsis and septic shock, from November 2007 to February 2013, at a tertiary hospital in Seoul, Korea. The outcome measured was 180-day all-cause mortality. A multivariate Cox proportional hazard model was used to identify the independent risk factors for mortality. A receiver operating characteristic (ROC) curve analysis was conducted to compare the predictive accuracy of the CRP/albumin ratio at admission.</p><p>Results</p><p>The 180-day mortality was 28.35% (190/670). Based on the multivariate Cox proportional hazard analysis, age, the CRP/albumin ratio at admission (adjusted HR 1.06, 95% CI 1.03–1.10, p<0.001), lactate level at admission (adjusted HR 1.10, 95% CI 1.05–1.14, p<0.001), and the Sequential Organ Failure Assessment (SOFA) score at admission (adjusted HR 1.12, 95% CI 1.07–1.18, p<0.001) were independent predictors of 180-day mortality. The area under the curve of CRP alone and the CRP/albumin ratio at admission for 180-day mortality were 0.5620 (P<0.001) and 0.6211 (P<0.001), respectively.</p><p>Conclusion</p><p>The CRP/albumin ratio was an independent predictor of mortality in patients with severe sepsis or septic shock.</p></div

Baseline features of the enrolled patients.

<p>The data was divided into two groups according to survival status at 180 days. Data are expressed as the mean ± SD / median (Q1-Q3) or N (%).</p><p>Abbreviations</p><p>¹CRP, C-reactive protein</p><p>²WBC, white blood cell count</p><p>³BUN, blood urea nitrogen</p><p>⁴Cr, creatinine</p><p>⁵CVP, central venous pressure (Goal of CVP in EGDT protocol: 8-12mm Hg)</p><p>⁶MAP, mean arterial pressure(Goal of CVP in EGDT protocol: >65 and ≤90mm Hg) and</p><p>⁷SCvO₂, central venous oxygen saturation(Goal of CVP in EGDT protocol: >70%)</p><p>⁸DM, diabetes mellitus</p><p>⁹ COPD, chronic obstructive pulmonary disease</p><p>¹⁰CHF, congestive heart failure</p><p>¹¹CRF, chronic renal failure</p><p>¹²SOFA, sequential organ failure assessment.</p><p>^a the number of patients who had available data was 524</p><p>^b the number of patients who had available data was 596</p><p>^c the number of patients who had available data was 496</p><p>^d the number of patients who had available data was 148</p><p>^e the number of patients who had available data was 663.</p><p>Baseline features of the enrolled patients.</p

Receiver operating characteristic (ROC) curve of CRP and CRP/albumin ratio in predicting 180-day mortality.

<p>The area under curve (AUC) for the CRP/albumin ratio is higher compared to CRP alone (p<0.001).</p

Cox proportional hazards analysis for 180-day mortality (CRP/albumin ratio at admission).

<p>¹The hazard ratio (HR) for death is expressed per 1-y increase in age, female to male in gender, per 1 unit increase in the SOFA score, 1 mg/L increase in CRP, 1 g/dL decrease in albumin, 1 increase in CRP (mg/dL)/albumin(g/dL), 1 mmol/dL increase in lactate and having malignancy to having no malignancy.</p><p>The multivariate analysis was adjusted for covariates such as age, gender, CRP/albumin ratio, SOFA score, lactate level and having malignancy or not, for each variable. Abbreviations: SOFA, sequential organ failure assessment; CRP, C-reactive protein</p><p>Cox proportional hazards analysis for 180-day mortality (CRP/albumin ratio at admission).</p

Kaplan-Meier analysis of the cumulative percentage of surviving patients at 180-days according to the different CRP/albumin levels.

<p>Patients with higher levels of CRP/albumin ratio had a reduced survival rate. Solid line, CRP/albumin ratio ≤5.09; dashed line, CRP/albumin ratio >5.09.</p

Cox proportional hazards analysis for 180-day mortality (CRP/albumin ratio at 72 h after admission).

<p>¹The hazard ratio (HR) for death is expressed per 1-y increase in age, female to male in gender, per 1 score increase in the SOFA score, 1 mg/L increase in CRP, 1 g/L decrease in albumin, 1 increase in CRP(mg/dL)/albumin(g/L), 1 mmol/dL increase in lactate and having malignancy to having no malignancy.</p><p>The multivariate analysis was adjusted for covariates such as age, gender, CRP/albumin ratio, SOFA score, lactate level and having malignancy or not, for each variable. Abbreviation: SOFA, sequential organ failure assessment; CRP, C-reactive protein.</p><p>Cox proportional hazards analysis for 180-day mortality (CRP/albumin ratio at 72 h after admission).</p