Title: Sepsis in intensive care – Prognosis and characterisation.

Main supervisor: Associate Professor Attila Frigyesi MD, PhD. 

Reviewers: 

Associate Professor Ulf Schött, MD, PhD.

Associate Professor Lars Lindberg, MD, PhD.

Abstract

Background

Sepsis is a leading cause of death in the world and is common in the intensive care unit (ICU). Prognostication of sepsis helps identify high-risk patients who may need timely ICU admission. Prognostic markers are also included in risk-adjustment models, routinely used for research and ICU quality control. One of these is the Simplified Acute Physiology Score 3 (SAPS-3). However, such models are developed for a general ICU population and include many variables. Simple and more accurate methods to predict outcomes in sepsis are needed. Furthermore, finding subgroups who may need specialised treatment would be valuable. 

Research questions

- How do established and new biomarkers perform in predicting sepsis outcomes?

- How can biomarkers help identify sepsis subgroups requiring specialised treatments?

- How can a combination of biomarkers and other clinical parameters predict outcomes or identify clinically relevant sepsis subgroups?

Preliminary results

In septic ICU patients, admission C-reactive protein (CRP) level >100 mg/L is associated with an increased risk of ICU and 30-day mortality and prolonged length of stay in survivors, irrespective of SAPS-3. 

SAPS-3 exhibits lower prognostic value in sepsis than in the general ICU population. A simple six-parameter model (Age, immunosuppression, Glasgow Coma Scale, body temperature, CRP and Bilirubin) predicts mortality comparably to SAPS-3 upon ICU admission for sepsis.

The novel biomarker Endostatin in plasma predicts acute kidney injury (AKI) and the need for renal replacement therapy in a general ICU population and sepsis patients.

Significance

CRP serves as a simple, early prognostic marker in ICU admissions for sepsis. A simple six-parameter model, including CRP, may allow the design of simple studies and performance monitoring in intensive care of sepsis. Endostatin appears to be a clinically valuable biomarker for AKI and dialysis needs in intensive care, including sepsis. 

Published studies

1. Koozi H, Lengquist M, Frigyesi A. C-reactive protein as a prognostic factor in intensive care admissions for sepsis: A Swedish multicenter study. J Crit Care. 2020 Apr;56:73-79.
2. Koozi H, Lidestam A, Lengquist M, Johnsson P, Frigyesi A. A simple mortality prediction model for sepsis patients in intensive care. J Intensive Care Soc. 2023 Nov;24(4):372-378.