Farhanah, Nur and Wahyono, Hendro and Gasem, Muhammad Hussein and Hadisaputro, Suharyo (2023) PERBANDINGAN ANTARA ENDOCAN DAN BIOMARKER LAIN SEBAGAI PREDIKTOR MORTALITAS PADA PASIEN SEPSIS (Kajian Neutrophyl-lymphocyte ratio, Prokalsitonin, Skor SOFA dan APACHE-II). Doctoral thesis, Universitas Diponegoro.

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Abstract

Background: Sepsis-3 is defined as a life-threatening condition of endothelium or organ failure. A biomarker or scoring system is required to ensure interventions can be carried out rapidly and accurately reducing mortality. Procalcitonin, neutrophil-lymphocyte ratio (NLR), SOFA and APACHE-II scores, are frequently used to assess the severity of sepsis and become predictor of mortality. Endocan, a specific proteoglycan released by vascular endothelial cells and induced by proinflammatory cytokines, is one of the most promising biomarkers for mortality prediction since
Aim: to prove whether endocan as a predictor of mortality is better than NLR, PCT, SOFAs, and APACHE-II score.
Methods: a prospective cohort study, sepsis-septic shock patients admitted to the ED of Dr. Kariadi Hospital. Clinical variables, complete blood count, endocan, PCT, NLR, were carried out within the first 24 hours when the patients admitted to the ED. The severity of sepsis was scored using the SOFA and APACHE-II scores. Bivariate, multivariate analyses using backward methods and logistic regression were used to predict 28-day of sepsis mortality.
Results: A total of 60 patients were included, 23 patients with sepsis (38.3%) and 37 patients with septic shock (61.7%); and 68.30% were died. Endocan was a good predictor of 28-days of mortality than NLR, PCT, SOFA score, and APACHE-II score (HR 2.47; p = 0.037; 95% CI 1.06–5.78). In this study, male was a predictor of mortality (HR 2.38; p = 0.009; 95% CI 1.24–4.59). The accuracy of endocan levels compared to the endocan plus NLR, PCT, SOFA, and APACHE-II scores was not good as a predictor of 28-day of mortality (AUC 0.599; 0.595; 0.607 ; 0.619; 0.595). The combination of endocan levels and male as a predictor of 28-days of sepsis mortality with higher accuracy than other combinations (AUC 0.722). The higher the PCT level, NLR value, SOFA, and APACHE scores, the higher the mortality.
Conclusion: In this study, endocan is a good predictor of sepsis mortality than NLR, PCT, SOFA, and APACHE-II scores. The combination of endocan levels and male gender as a predictor of 28-day of sepsis mortality has higher accuracy than other combinations. High and low levels of biomarkers influence 28-day of sepsis mortality.
Keywords: endocan, biomarkers, scoring systems, predictor of mortality

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