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Association of Serum Calprotectin Concentrations with Mortality in Critically Ill and Septic Patients
Theresa H Wirtz1, Lukas Buendgens1, Ralf Weiskirchen2
1Department of Medicine III, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
Insights
Serum calprotectin is elevated in critical illness and sepsis. High levels at ICU admission predict mortality risk, but increasing levels indicate a favorable outcome for critically ill patients.
Area of Science:
- Biochemistry and Molecular Biology
- Critical Care Medicine
- Immunology
Background:
- Calprotectin, a neutrophil protein, is released upon activation.
- Fecal calprotectin aids inflammatory bowel disease management.
- Serum calprotectin's prognostic value in critical illness is under-explored.
Purpose of the Study:
- Investigate serum calprotectin as a prognostic biomarker in critically ill and septic patients.
- Determine the association between serum calprotectin levels and patient outcomes.
Main Methods:
- Serum calprotectin measured in 165 critically ill patients (108 sepsis, 57 no sepsis) and 24 healthy controls.
- Correlated calprotectin with clinical parameters, interventions, and survival.
- Analyzed baseline and week-one changes in calprotectin concentrations.
Main Results:
- Serum calprotectin significantly elevated in ICU and septic patients versus controls.
- Lower calprotectin observed in patients with comorbidities like coronary artery disease.
- High baseline calprotectin correlated with impaired survival; increasing levels associated with improved survival.
Conclusions:
- Serum calprotectin is significantly elevated in critically ill septic patients.
- High initial calprotectin predicts long-term mortality risk.
- Increasing serum calprotectin concentrations indicate a favorable long-term prognosis.
Abstract:
Background: Calprotectin is present in the cytosol of neutrophil granulocytes and released upon activation. Fecal calprotectin is applied in the clinical management of inflammatory bowel disease whereas serum calprotectin has been discussed as a biomarker in inflammatory disorders. However, its long-term prognostic relevance in critical illness remains unclear. Our aim was to investigate serum calprotectin concentrations as a prognostic biomarker in critically ill and septic patients. Methods: Serum calprotectin concentrations were analyzed in 165 critically ill patients (108 with sepsis, 57 without sepsis) included in our observational study. Patients were enrolled upon admission to the medical intensive care unit (ICU) of the RWTH Aachen University Hospital. Calprotectin concentrations were compared to 24 healthy controls and correlated with clinical parameters, therapeutic interventions, and survival. Results: Serum calprotectin concentrations were significantly increased in ICU patients as well as in septic patients compared to respective controls (p < 0.001 for ICU patients and p = 0.001 for septic patients). Lower calprotectin concentrations were measured in patients with comorbidities i.e., coronary artery disease. Calprotectin concentrations strongly correlated with the C-reactive protein (p < 0.001) and were closely associated to parameters of mechanical ventilation (i.a. inspiratory oxygen fraction, FiO2; p < 0.001). The overall survival was significantly impaired in septic patients with high baseline calprotectin concentrations (p = 0.036). However, patients with increasing calprotectin serum concentrations within the first week of ICU admission showed an improved overall survival (p = 0.009). Conclusions: In summary, serum calprotectin concentrations are significantly increased in critically ill patients with sepsis. High calprotectin concentrations at ICU admission predict long-term mortality risk, whereas increasing calprotectin concentrations are associated with a favorable long-term outcome.
