Background
Methods
Patients and setting
Intended management
Definitions
Immunological measurements
Immune multiplex molecular tool
Calculation of the transcriptomic score and statistical analysis
Results
Training cohort
No ICU-AI (n = 129) | ICU-AI (n = 47) | p-value | |
---|---|---|---|
Baseline characteristics | |||
Subgroup | |||
Burn | 2 (2) | 14 (30) | < 0.001 |
Sepsis/Septic shock | 57 (44) | 11 (23) | |
Surgery | 11 (9) | 9 (19) | |
Trauma | 59 (46) | 13 (28) | |
Female gender | 33 (26) | 14 (30) | 0.715 |
Age, years | 61 (47–73) | 59 (46–70) | 0.446 |
Comorbidities | |||
Diabetes mellitus | 19 (14) | 10 (21) | 0.420 |
Chronic renal failure | 13 (9) | 1 (2) | 0.117 |
Chronic pulmonary disease | 13 (9) | 9 (19) | 0.176 |
HIV infection | 0 (0) | 0 (0) | / |
Solid tumors | 22 (16) | 9 (19) | 0.921 |
Hematological malignancy | 0 (0) | 0 (0) | / |
Body mass index, kg/m2 | 25 (22–28) | 25 (22–29) | 0.983 |
Parameters at ICU admission | |||
SAPS II score | 35 (24–47) | 38 (29–48) | 0.401 |
SOFA score | 6 (2–9) | 7 (5–9) | 0.134 |
Lactate, mmol/L | 0.8 (0–2.6) | 1.2 (0–2.6) | 0.727 |
Mechanical ventilation | 69 (53) | 37 (79) | 0.004 |
Norepinephrine or epinephrine use | 88 (68) | 40 (85) | 0.042 |
Outcomes | |||
Duration of mechanical ventilation, days | 1 (0–3) | 15 (1–29) | < 0.001 |
Death in ICU | 7 (5) | 8 (17) | 0.028 |
In hospital mortality | 17 (13) | 6 (13) | 0.367 |
Genes | AUC | Cut-off value | Specificity | Sensitivity |
---|---|---|---|---|
C3AR1 | 0.73 (0.65–0.80) | > 0.360 | 0.63 (0.55–0.71) | 0.83 (0.70–0.91) |
CD177 | 0.76 (0.68–0.84) | > 2.867 | 0.73 (0.65–0.80) | 0.68 (0.54–0.79) |
CX3CR1 | 0.73 (0.64–0.81) | < − 1.679 | 0.62 (0.53–0.70) | 0.72 (0.59–0.83) |
IFNγ | 0.73 (0.64–0.81) | < − 6.601 | 0.95 (0.90–0.98) | 0.40 (0.27–0.55) |
IL1R2 | 0.77 (0.70–0.84) | > 3.894 | 0.70 (0.61–0.77) | 0.85 (0.72–0.93) |
S100A9 | 0.71 (0.62–0.79) | > − 0.189 | 0.70 (0.62–0.77) | 0.66 (0.52–0.78) |
TDRD9 | 0.74 (0.65–0.82) | > 1.923 | 0.87 (0.80–0.92) | 0.51 (0.37–0.64) |
ZAP70 | 0.74 (0.65–0.81) | < 2.482 | 0.65 (0.57–0.73) | 0.71 (0.50–0.86) |
TScore [0–2] (n = 89) | TScore [3–8] (n = 87) | p-value | |
---|---|---|---|
Baseline characteristics | |||
Subgroup | < 0.001 | ||
Burn | 0 (0) | 16 (18) | |
Sepsis/Septic shock | 29 (33) | 39 (45) | |
Surgery | 5 (6) | 15 (17) | |
Trauma | 55 (62) | 17 (20) | |
Female gender | 20 (22) | 27 (31) | 0.266 |
Age, years | 54 (43–66) | 65 (49–76) | 0.004 |
Body mass index, kg/m2 | 25 (23–27) | 26 (23–30) | 0.314 |
Parameters at ICU admission | |||
SAPS II score | 34 (23–41) | 43 (30–54) | < 0.001 |
SOFA score | 5 (1–8) | 8 (5–11) | < 0.001 |
Lactate, mmol/L | 0 (0–2.1) | 1.6 (0–3.2) | 0.078 |
Mechanical ventilation | 41 (46) | 65 (75) | < 0.001 |
Norepinephrine or epinephrine use | 54 (61) | 74 (85) | < 0.001 |
Outcomes | |||
ICU length of stay, days | 7 (6–9) | 13 (8–30) | < 0.001 |
ICU-acquired infections | 4 (4) | 43 (49) | < 0.001 |
Pneumonia | 2 | 19 | |
Urinary tract infection | 2 | 9 | |
Others | 0 | 15 | |
Death in the ICU | 2 (2) | 13 (15) | 0.006 |
In hospital mortality | 9 (10) | 14 (16) | 0.114 |
Univariate analysis | p-value |
---|---|
Age, years | 0.89 |
Charlson score | 0.66 |
SAPSII score | 0.46 |
SOFA at day 6 | 0.0079 |
TScore | 3.8 × 10–9 |
Multivariate analysis | Estimate | p-value |
---|---|---|
SOFA at day 6 | − 0.06 | 0.32 |
TScore | 0.6 | 6.4 × 10–9 |
Burn | Sepsis | Surgery | Trauma | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Low Risk (n = 0) | High Risk (n = 16) | Low Risk (n = 29) | High Risk (n = 39) | p | Low Risk (n = 5) | High Risk (n = 15) | p | Low Risk (n = 55) | High Risk (n = 17) | p | |
SAPS II at admission | / | 37 [29–42] | 40 [36–49] | 53 [46–62] | < 0.001 | 26 [25–27] | 25 [22–31] | 0.521 | 26 [21–38] | 35 [29–45] | 0.042 |
SOFA at admission | / | 6 [5–8] | 8 [6–10] | 10 [8–12] | 0.002 | 3 [3, 4] | 5 [2–6] | 0.347 | 2 [0–7] | 7 [3–11] | 0.008 |
Lactate at admission | / | 1.9 [0.0–3.6] | 1.3 [0.0–2.1] | 2.5 [0.0–3.6] | 0.040 | 0.0 [0.0–0.0] | 0.0 [0.0–0.0] | / | 0.0 [0.0–2.1] | 1.6 [0.0–2.8] | 0.150 |
Mechanical ventilation | / | 14 (87.5%) | 20 (69.0%) | 34 (87.2%) | 0.125 | 0 (0.0%) | 3 (20.0%) | 0.539 | 21 (38.2%) | 14 (82.4%) | 0.004 |
Norepinephrine or epinephrine use | / | 14 (87.5%) | 27 (93.1%) | 38 (97.4%) | 0.571 | 2 (40.0%) | 9 (60.0%) | 0.617 | 25 (45.5%) | 13 (76.5%) | 0.050 |
ICU length of stay, days | / | 53 [39–62] | 7 [6–8] | 13 [10–19] | < 0.001 | 7 [6, 7] | 8 [6–9] | 0.056 | 8 [6–9] | 18 [12–33] | < 0.001 |
Mechanical ventilation duration, days | / | 26 [16–44] | 3 [0–5] | 3 [1–8] | 0.201 | 0 [0–0] | 0 [0–0] | 0.326 | 0 [0–1] | 5 [1–23] | < 0.001 |
Death in the ICU | / | 4 (25.0%) | 2 (6.9%) | 7 (17.9%) | 0.282 | / | / | / | 0 (0.0%) | 2 (11.8%) | 0.053 |
In hospital mortality | / | 3 18.8%) | 8 (27.6%) | 10 (25.6%) | 1.000 | / | / | 1.000 | 1 (1.8%) | 1 (5.9%) | 0.419 |
ICU-acquired infections | / | 14 (87.5%) | 0 (0.0%) | 11 (28.2%) | 0.002 | 0 (0.0%) | 9 (60.0%) | 0.038 | 4 (7.3%) | 9 (52.9%) | < 0.001 |
Validation cohort
TScore [0–2] (n = 97) | TScore [3–8] (n = 160) | p-value | |
---|---|---|---|
Baseline characteristics | |||
Female gender | 34 (35) | 63 (39) | 0.575 |
Age, years | 64 (54–75) | 66 (57–77) | 0.414 |
Comorbidities | |||
Diabetes mellitus | 22 (22) | 25 (15) | 0.211 |
Chronic renal failure | 10 (10) | 11 (7) | 0.460 |
Chronic pulmonary disease | 32 (33) | 44 (27) | 0.427 |
HIV infection | 1 (1) | 1 (1) | 1.000 |
Solid tumors | 19 (20) | 44 (28) | 0.201 |
Hematological malignancy | 5 (5) | 1 (1) | 0.030 |
Parameters at ICU admission | |||
SAPS II score | 56 (40–69) | 60 (48–70) | 0.061 |
SOFA score | 8 (6–10) | 10 (8–13) | < 0.001 |
Lactate, mmol/L | 1.8 (1.2–2.9) | 2.4 (1.6–3.6) | < 0.001 |
Mechanical ventilation | 75 (77) | 140 (87) | 0.049 |
Norepinephrine or epinephrine use | 62 (64) | 123 (77) | 0.036 |
Outcomes | |||
ICU length of stay, days | 9 (7–14) | 12 (8–20) | 0.003 |
Duration of mechanical ventilation, days | 6 (3–14) | 9 (5–16) | 0.011 |
ICU-acquired infections | 18 (18) | 47 (30) | 0.056 |
Pneumonia | 10 | 32 | 0.134 |
Urinary tract infection | 6 | 8 | |
Others | 2 | 7 | |
Death in ICU | 13 (13) | 47 (29) | 0.006 |