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- Hector R Wong, Patrick Lahni, Christopher J Lindsell, and Kimberly W Hart.
- 1Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Hospital Research Foundation, Cincinnati, OH, USA. 2Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA. 3Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA. 4Réanimation Médicale, Hôpital Central, Nancy, France. 5INSERM UMR_S 1116, Equipe TREM, Faculté de Médecine, Université de Lorraine, Nancy, France.
- Shock. 2013 Oct 1.
PurposeWe previously identified interleukin-27 (IL-27) as a sepsis diagnostic biomarker in critically ill children. The current study tested the performance of IL-27 alone and in combination with PCT for diagnosing sepsis in critically ill adults.MethodsSerum samples were made available from a prior prospective study of sepsis biomarkers in critically ill adults. The primary analysis used receiver operating characteristic (ROC) curves to evaluate the performance of IL-27 and PCT. Secondary analysis explored IL-27 performance in subgroups of patients with sepsis secondary to lung and non-lung sources of infection. The net reclassification improvement (NRI) was used to estimate the incremental predictive ability of IL-27 compared to PCT alone. Classification and Regression Tree (CART) analysis was used to generate an IL-27- and PCT-based decision tree.ResultsThere were 145 patients with sepsis and 125 without sepsis. The ROC curve for IL-27 was inferior (area under the curve [AUC]: 0.68; 95% CI: 0.62 - 0.75) to that of PCT (AUC: 0.84; 95% CI: 0.79 - 0.89). Similar findings were observed when comparing patients with a lung source of infection and those without sepsis. For sepsis patients with a non-lung source of infection, adding IL-27 to PCT improved discrimination (NRI = 0.685; p < 0.001). The AUC for the CART-derived decision tree was 0.92 (95% CI: 0.88 - 0.96) and was significantly greater than that of PCT alone.ConclusionsWhen used in combination with PCT, IL-27 may improve classification of critically ill adults with sepsis secondary to a non-lung source of infection.
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