Prognostic Value of Secretoneurin in Patients with Severe Sepsis and Septic Shock: Data from the Albumin Italian Outcome Sepsis Study

Helge Røsjø, Serge Masson, Pietro Caironi, Mats Stridsberg, Michela Magnoli, Geir Christensen, Gabriella Moise, Maria Cristina Urbano, Luciano Gattinoni, Antonio Pesenti, Roberto Latini, Torbjørn Omland

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objectives: Secretoneurin directly influences cardiomyocyte calcium handling, and circulating secretoneurin levels seem to improve risk prediction in patients with myocardial dysfunction by integrating information on systemic stress, myocardial function, and renal function. Accordingly, in this study, we hypothesized that secretoneurin would improve risk prediction in patients with sepsis and especially in patients with septic shock as these patients are more hemodynamically unstable. Design: Multicenter, interventional randomized clinical trial. Setting: Multicenter, pragmatic, open-label, randomized, prospective clinical trial testing fluid administration with either 20% human albumin and crystalloids or crystalloid solutions alone in patients with severe sepsis or septic shock (The Albumin Italian Outcome Sepsis). Patients or Subjects: In total, 540 patients with septic shock and 418 patients with severe sepsis. Interventions: Either 20% human albumin and crystalloids or crystalloid solutions alone. Measurements and Main Results: We measured secretoneurin on days 1, 2, and 7 after randomization and compared the prognostic value of secretoneurin for ICU and 90-day mortality with established risk indices and cardiac biomarkers in septic shock and severe sepsis. High secretoneurin levels on day 1 were associated with age and serum concentrations of lactate, bilirubin, creatinine, and N-terminal pro-B-type natriuretic peptide. Adjusting for established risk factors and cardiovascular biomarkers, secretoneurin levels on day 1 were associated with ICU (odds ratio, 2.27 [95% CI, 1.05-4.93]; p = 0.04) and 90-day mortality (2.04 [1.02-4.10]; p = 0.04) in patients with septic shock, but not severe sepsis without shock. Secretoneurin levels on day 2 were also associated with ICU (3.11 [1.34-7.20]; p = 0.008) and 90-day mortality (2.69 [1.26-5.78]; p = 0.01) in multivariate regression analyses and improved reclassification in patients with septic shock, as assessed by the net reclassification index. Randomized albumin administration did not influence the associations between secretoneurin and outcomes. Conclusions: Secretoneurin provides early and potent prognostic information in septic patients with cardiovascular instability.

Original languageEnglish
Pages (from-to)e404-e410
JournalCritical Care Medicine
Volume46
Issue number5
DOIs
Publication statusPublished - May 1 2018

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Septic Shock
Albumins
Sepsis
Outcome Assessment (Health Care)
Mortality
secretoneurin
Randomized Controlled Trials
Biomarkers
Brain Natriuretic Peptide
Random Allocation
Bilirubin
Cardiac Myocytes
Shock
Lactic Acid
Creatinine
Multivariate Analysis
Odds Ratio
Regression Analysis
Calcium
Kidney

Keywords

  • biomarkers
  • secretoneurin
  • sepsis
  • septic shock

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Prognostic Value of Secretoneurin in Patients with Severe Sepsis and Septic Shock : Data from the Albumin Italian Outcome Sepsis Study. / Røsjø, Helge; Masson, Serge; Caironi, Pietro; Stridsberg, Mats; Magnoli, Michela; Christensen, Geir; Moise, Gabriella; Urbano, Maria Cristina; Gattinoni, Luciano; Pesenti, Antonio; Latini, Roberto; Omland, Torbjørn.

In: Critical Care Medicine, Vol. 46, No. 5, 01.05.2018, p. e404-e410.

Research output: Contribution to journalArticle

Røsjø, H, Masson, S, Caironi, P, Stridsberg, M, Magnoli, M, Christensen, G, Moise, G, Urbano, MC, Gattinoni, L, Pesenti, A, Latini, R & Omland, T 2018, 'Prognostic Value of Secretoneurin in Patients with Severe Sepsis and Septic Shock: Data from the Albumin Italian Outcome Sepsis Study', Critical Care Medicine, vol. 46, no. 5, pp. e404-e410. https://doi.org/10.1097/CCM.0000000000003050
Røsjø, Helge ; Masson, Serge ; Caironi, Pietro ; Stridsberg, Mats ; Magnoli, Michela ; Christensen, Geir ; Moise, Gabriella ; Urbano, Maria Cristina ; Gattinoni, Luciano ; Pesenti, Antonio ; Latini, Roberto ; Omland, Torbjørn. / Prognostic Value of Secretoneurin in Patients with Severe Sepsis and Septic Shock : Data from the Albumin Italian Outcome Sepsis Study. In: Critical Care Medicine. 2018 ; Vol. 46, No. 5. pp. e404-e410.
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AU - Caironi, Pietro

AU - Stridsberg, Mats

AU - Magnoli, Michela

AU - Christensen, Geir

AU - Moise, Gabriella

AU - Urbano, Maria Cristina

AU - Gattinoni, Luciano

AU - Pesenti, Antonio

AU - Latini, Roberto

AU - Omland, Torbjørn

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N2 - Objectives: Secretoneurin directly influences cardiomyocyte calcium handling, and circulating secretoneurin levels seem to improve risk prediction in patients with myocardial dysfunction by integrating information on systemic stress, myocardial function, and renal function. Accordingly, in this study, we hypothesized that secretoneurin would improve risk prediction in patients with sepsis and especially in patients with septic shock as these patients are more hemodynamically unstable. Design: Multicenter, interventional randomized clinical trial. Setting: Multicenter, pragmatic, open-label, randomized, prospective clinical trial testing fluid administration with either 20% human albumin and crystalloids or crystalloid solutions alone in patients with severe sepsis or septic shock (The Albumin Italian Outcome Sepsis). Patients or Subjects: In total, 540 patients with septic shock and 418 patients with severe sepsis. Interventions: Either 20% human albumin and crystalloids or crystalloid solutions alone. Measurements and Main Results: We measured secretoneurin on days 1, 2, and 7 after randomization and compared the prognostic value of secretoneurin for ICU and 90-day mortality with established risk indices and cardiac biomarkers in septic shock and severe sepsis. High secretoneurin levels on day 1 were associated with age and serum concentrations of lactate, bilirubin, creatinine, and N-terminal pro-B-type natriuretic peptide. Adjusting for established risk factors and cardiovascular biomarkers, secretoneurin levels on day 1 were associated with ICU (odds ratio, 2.27 [95% CI, 1.05-4.93]; p = 0.04) and 90-day mortality (2.04 [1.02-4.10]; p = 0.04) in patients with septic shock, but not severe sepsis without shock. Secretoneurin levels on day 2 were also associated with ICU (3.11 [1.34-7.20]; p = 0.008) and 90-day mortality (2.69 [1.26-5.78]; p = 0.01) in multivariate regression analyses and improved reclassification in patients with septic shock, as assessed by the net reclassification index. Randomized albumin administration did not influence the associations between secretoneurin and outcomes. Conclusions: Secretoneurin provides early and potent prognostic information in septic patients with cardiovascular instability.

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