Procalcitonin-to-albumin ratio as a prognostic marker in acute respiratory distress syndrome patients: a retrospective cohort study_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WANG Yu , HUANG Dong ,  LIANG Zongan

Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

LIANG Zongan, Email: liangza@scu.edu.cn

Keywords：

Procalcitonin; Albumin; Acute respiratory distress syndrome; Acute lung injury

DOI：

10.7507/1671-6205.201907077

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Objective To explore the value of procalcitonin-to-albumin (PAR) in patients with acute respiratory distress syndrome (ARDS).Methods A retrospective study was carried on patients diagnosed with ARDS from December 2016 to March 2018. The receiver-operating characteristics (ROC) curve was used to identify the cutoff value of PAR. The association of PAR and 28-day mortality was evaluated using univariate and multivariable Cox regression.Results In the final analysis, there were a total of 255 patients included. Of whom 164 (64.3%) was male, 91 (35.7%) was female and the mean age was 52.1±14.5 years old. The 28-day mortality of all the patients was 32.9% (n=84). ROC curve revealed that the cutoff value of PAR was 0.039 (specificity: 0.714, sensitivity: 0.702) and area under the curve was 0.793 (95%CI: 0.735 - 0.850, P<0.001). The following variables were considered for multivariable adjustment: age, body mass index, pneumonia, aspiration, sepsis, surgery, PaO₂/FiO₂, red blood cell counts and PAR (P<0.01 in univariate analysis). After multivariable analysis, only age (HR: 1.033, 95%CI: 1.009 - 1.059, P=0.008), PaO₂/FiO₂ (HR: 0.992, 95%CI: 0.985 - 1.000, P=0.044) and PAR (HR: 4.899, 95%CI: 2.148 - 11.174, P<0.001) remained independently associated with 28-day mortality (P<0.05).Conclusion High PAR predicts a poor outcome in ARDS patients, therefore it appears to be a prognostic biomarker of outcomes in patients with ARDS.

Citation： WANG Yu, HUANG Dong, LIANG Zongan. Procalcitonin-to-albumin ratio as a prognostic marker in acute respiratory distress syndrome patients: a retrospective cohort study. Chinese Journal of Respiratory and Critical Care Medicine, 2020, 19(3): 240-245. doi: 10.7507/1671-6205.201907077 Copy

1.	Fujishima S. Pathophysiology and biomarkers of acute respiratory distress syndrome. J Intensive Care Med, 2014, 2(1): 32.
2.	Ashbaugh DG, Bigelow DB, Petty TL, et al. Acute respiratory distress in adults. Lancet, 1967, 290(7511): 319-323.
3.	Schmickl CN, Biehl M, Wilson GA, et al. Comparison of hospital bortality and long-term survival in patients with acute lung injury/ARDS vs cardiogenic pulmonary edema. Chest, 2015, 147(3): 618-625.
4.	Villar J, Blanco J, Kacmarek RM. Current incidence and outcome of the acute respiratory distress syndrome. Curr Opin Crit Care, 2016, 22(1): 1-6.
5.	虞志新, 吉木森, 胡秀蘭, 等. 降鈣素原對 ARDS 患者早期病情評估及預后的判斷價值: 一項前瞻性觀察性研究. 中華危重病急救醫學, 2017, 29(1): 34-38.
6.	Tseng JS, Chan MC, Hsu JY, et al. Procalcitonin is a valuable prognostic marker in ARDS caused by community-acquired pneumonia. Respirology, 2010, 13(4): 505-509.
7.	Yap FH, Joynt GM, Buckley TA, et al. Association of serum albumin concentration and mortality risk in critically ill patients. Anaesth Intensive Care, 2002, 30(2): 202.
8.	Villota EDD, Mosquera JM, Rubio JJ, et al. Association of a low serum albumin with infection and increased mortality in critically ill patients. Intensive Care Med, 1980, 7(1): 19-22.
9.	Gundpatil DB, Somani BL, Saha TK, et al. Serum urea: albumin ratio as a prognostic marker in critical patients with non-chronic kidney disease. Indian J Clin Biochem, 2014, 29(1): 97-100.
10.	Aman J, Melanie VDH, Lingen AV, et al. Plasma protein levels are markers of pulmonary vascular permeability and degree of lung injury in critically ill patients with or at risk for acute lung injury/acute respiratory distress syndrome. Crit Care Med, 2011, 39(1): 89-97.
11.	張意. 血清白蛋白和前白蛋白對 ARDS 患者死亡預后的評估作用. 中國臨床新醫學, 2013, 6(10): 965-968.
12.	Kaplan M, Ates I, Akpinar MY, et al. Predictive value of C-reactive protein/albumin ratio in acute pancreatitis. Hepatobiliary Pancreat Dis Int, 2017, 16(4): 424-430.
13.	Fan ZY, Fan K, Gong YT, et al. The CRP/albumin ratio predicts survival and monitors chemotherapeutic effectiveness in patients with advanced pancreatic cancer. Cancer Manag Res, 2019, 11: 8781-8788.
14.	Park JE, Chung KS, Song JH, et al. The C-reactive protein/albumin ratio as a predictor of mortality in critically ill patients. J Clin Med, 2018, 7(10): 333.
15.	Luo X, Yang X, Li J, et al. The procalcitonin/albumin ratio as an early diagnostic predictor in discriminating urosepsis from patients with febrile urinary tract infection. Medicine (Baltimore), 2018, 97(28): e11078.
16.	Force ADT, VM R, GD R, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012, 307(23): 2526.
17.	Zhao Z, Wickersham N, Kangelaris KN, et al. External validation of a biomarker and clinical prediction model for hospital mortality in acute respiratory distress syndrome. Intensive Care Med, 2017, 43(8): 1123-1131.
18.	Bauman ZM, Gassner MY, Coughlin MA, et al. Lung injury prediction score is useful in predicting acute respiratory distress syndrome and mortality in surgical critical care patients. Crit Care Res Pract, 2015, 2015: 157408.
19.	Krzak A, Pleva M, Napolitano LM. Nutrition therapy for ALI and ARDS. Crit Care Clin, 2011, 27(3): 647-659.
20.	Stapleton RD, Suratt BT. Obesity and nutrition in acute respiratory distress syndrome. Clin Chest Med, 2014, 35(4): 655-671.
21.	Wu CY, Hu HY, Huang N, et al. Albumin levels and cause-specific mortality in community-dwelling older adults. Prev Med, 2018, 112: 145-151.
22.	Hoeboer SH, Straaten HMO, Groeneveld AJ. Albumin rather than C-reactive protein may be valuable in predicting and monitoring the severity and course of acute respiratory distress syndrome in critically ill patients with or at risk for the syndrome after new onset fever. BMC Pulm Med, 2015, 15(1): 22.
23.	Davies J. Procalcitonin. J Clin Pathol, 2015, 68(9): 675.
24.	Tsantes A, Tsangaris I, Kopterides P, et al. The role of procalcitonin and IL-6 in discriminating between septic and non-septic causes of ALI/ARDS: a prospective observational study. Clin Chem Lab Med, 2013, 51(7): 1535-1542.
25.	Hoeboer SH, Groeneveld ABJ, Melanie VDH, et al. Serial inflammatory biomarkers of the severity, course and outcome of late onset acute respiratory distress syndrome in critically ill patients with or at risk for the syndrome after new-onset fever. Biomark Med, 2015, 9(6): 605-616.
26.	陸月明, 王莉, 張夢, 等. 血清降鈣素原水平對 ARDS 患者預后的臨床預測價值. 臨床肺科雜志, 2015, 20(8): 1141-1143.
27.	Meduri GU, Annane D, Chrousos GP, et al. Activation and regulation of systemic inflammation in ARDS : rationale for prolonged glucocorticoid therapy. Chest, 2009, 136(6): 1631-1643.
28.	Assicot M, Gendrel D, Carsin H, et al. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet, 1993, 341(8844): 515-518.
29.	秦妮, 段亞楠, 米婷. 血清降鈣素原和 C 反應蛋白檢測對急性呼吸窘迫綜合征合并肺部感染患者預后的評估價值. 海南醫學, 2019, 30(22): 2887-2889.
30.	Deng S, Gao J, Zhao Z, et al. Albumin/procalcitonin ratio is a sensitive early marker of nosocomial blood stream infection in patients with intra-cerebral hemorrhage. Surg Infect (Larchmt), 2019, 20(8): 643-649.

1. Fujishima S. Pathophysiology and biomarkers of acute respiratory distress syndrome. J Intensive Care Med, 2014, 2(1): 32.
2. Ashbaugh DG, Bigelow DB, Petty TL, et al. Acute respiratory distress in adults. Lancet, 1967, 290(7511): 319-323.
3. Schmickl CN, Biehl M, Wilson GA, et al. Comparison of hospital bortality and long-term survival in patients with acute lung injury/ARDS vs cardiogenic pulmonary edema. Chest, 2015, 147(3): 618-625.
4. Villar J, Blanco J, Kacmarek RM. Current incidence and outcome of the acute respiratory distress syndrome. Curr Opin Crit Care, 2016, 22(1): 1-6.
5. 虞志新, 吉木森, 胡秀蘭, 等. 降鈣素原對 ARDS 患者早期病情評估及預后的判斷價值: 一項前瞻性觀察性研究. 中華危重病急救醫學, 2017, 29(1): 34-38.
6. Tseng JS, Chan MC, Hsu JY, et al. Procalcitonin is a valuable prognostic marker in ARDS caused by community-acquired pneumonia. Respirology, 2010, 13(4): 505-509.
7. Yap FH, Joynt GM, Buckley TA, et al. Association of serum albumin concentration and mortality risk in critically ill patients. Anaesth Intensive Care, 2002, 30(2): 202.
8. Villota EDD, Mosquera JM, Rubio JJ, et al. Association of a low serum albumin with infection and increased mortality in critically ill patients. Intensive Care Med, 1980, 7(1): 19-22.
9. Gundpatil DB, Somani BL, Saha TK, et al. Serum urea: albumin ratio as a prognostic marker in critical patients with non-chronic kidney disease. Indian J Clin Biochem, 2014, 29(1): 97-100.
10. Aman J, Melanie VDH, Lingen AV, et al. Plasma protein levels are markers of pulmonary vascular permeability and degree of lung injury in critically ill patients with or at risk for acute lung injury/acute respiratory distress syndrome. Crit Care Med, 2011, 39(1): 89-97.
11. 張意. 血清白蛋白和前白蛋白對 ARDS 患者死亡預后的評估作用. 中國臨床新醫學, 2013, 6(10): 965-968.
12. Kaplan M, Ates I, Akpinar MY, et al. Predictive value of C-reactive protein/albumin ratio in acute pancreatitis. Hepatobiliary Pancreat Dis Int, 2017, 16(4): 424-430.
13. Fan ZY, Fan K, Gong YT, et al. The CRP/albumin ratio predicts survival and monitors chemotherapeutic effectiveness in patients with advanced pancreatic cancer. Cancer Manag Res, 2019, 11: 8781-8788.
14. Park JE, Chung KS, Song JH, et al. The C-reactive protein/albumin ratio as a predictor of mortality in critically ill patients. J Clin Med, 2018, 7(10): 333.
15. Luo X, Yang X, Li J, et al. The procalcitonin/albumin ratio as an early diagnostic predictor in discriminating urosepsis from patients with febrile urinary tract infection. Medicine (Baltimore), 2018, 97(28): e11078.
16. Force ADT, VM R, GD R, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012, 307(23): 2526.
17. Zhao Z, Wickersham N, Kangelaris KN, et al. External validation of a biomarker and clinical prediction model for hospital mortality in acute respiratory distress syndrome. Intensive Care Med, 2017, 43(8): 1123-1131.
18. Bauman ZM, Gassner MY, Coughlin MA, et al. Lung injury prediction score is useful in predicting acute respiratory distress syndrome and mortality in surgical critical care patients. Crit Care Res Pract, 2015, 2015: 157408.
19. Krzak A, Pleva M, Napolitano LM. Nutrition therapy for ALI and ARDS. Crit Care Clin, 2011, 27(3): 647-659.
20. Stapleton RD, Suratt BT. Obesity and nutrition in acute respiratory distress syndrome. Clin Chest Med, 2014, 35(4): 655-671.
21. Wu CY, Hu HY, Huang N, et al. Albumin levels and cause-specific mortality in community-dwelling older adults. Prev Med, 2018, 112: 145-151.
22. Hoeboer SH, Straaten HMO, Groeneveld AJ. Albumin rather than C-reactive protein may be valuable in predicting and monitoring the severity and course of acute respiratory distress syndrome in critically ill patients with or at risk for the syndrome after new onset fever. BMC Pulm Med, 2015, 15(1): 22.
23. Davies J. Procalcitonin. J Clin Pathol, 2015, 68(9): 675.
24. Tsantes A, Tsangaris I, Kopterides P, et al. The role of procalcitonin and IL-6 in discriminating between septic and non-septic causes of ALI/ARDS: a prospective observational study. Clin Chem Lab Med, 2013, 51(7): 1535-1542.
25. Hoeboer SH, Groeneveld ABJ, Melanie VDH, et al. Serial inflammatory biomarkers of the severity, course and outcome of late onset acute respiratory distress syndrome in critically ill patients with or at risk for the syndrome after new-onset fever. Biomark Med, 2015, 9(6): 605-616.
26. 陸月明, 王莉, 張夢, 等. 血清降鈣素原水平對 ARDS 患者預后的臨床預測價值. 臨床肺科雜志, 2015, 20(8): 1141-1143.
27. Meduri GU, Annane D, Chrousos GP, et al. Activation and regulation of systemic inflammation in ARDS : rationale for prolonged glucocorticoid therapy. Chest, 2009, 136(6): 1631-1643.
28. Assicot M, Gendrel D, Carsin H, et al. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet, 1993, 341(8844): 515-518.
29. 秦妮, 段亞楠, 米婷. 血清降鈣素原和 C 反應蛋白檢測對急性呼吸窘迫綜合征合并肺部感染患者預后的評估價值. 海南醫學, 2019, 30(22): 2887-2889.
30. Deng S, Gao J, Zhao Z, et al. Albumin/procalcitonin ratio is a sensitive early marker of nosocomial blood stream infection in patients with intra-cerebral hemorrhage. Surg Infect (Larchmt), 2019, 20(8): 643-649.

Chinese Journal of Respiratory and Critical Care Medicine

Procalcitonin-to-albumin ratio as a prognostic marker in acute respiratory distress syndrome patients: a retrospective cohort study

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