Ann Lab Med.  2015 Nov;35(6):570-577. 10.3343/alm.2015.35.6.570.

Soluble ST2 Has a Prognostic Role in Patients With Suspected Sepsis

• Hur M
• Kim H
• Kim HJ
• Yang HS
• Magrini L
• Marino R
• Cardelli P
• Di Somma S
• GREAT Network

• KMID: 2363259
• DOI: http://doi.org/10.3343/alm.2015.35.6.570

Abstract

BACKGROUND
Soluble suppression of tumorigenicity 2 (sST2) has emerged as a novel biomarker for heart failure, and serum sST2 concentrations could be increased in inflammatory diseases. We explored whether sST2 is related to cardiac dysfunction/failure and has a prognostic role in patients with suspected sepsis.
METHODS
In a total of 397 patients with suspected sepsis, sST2 concentrations were measured by using the Presage ST2 Assay (Critical Diagnostics, USA). sST2 concentrations were analyzed according to procalcitonin (PCT) concentrations, cardiovascular subscores of the sepsis-related organ failure assessment (SOFA) score, and clinical outcomes.
RESULTS
sST2 concentrations were increased significantly according to the five groups of PCT concentrations and cardiovascular subscores of the SOFA score (P<0.000001 and P=0.036, respectively). In-hospital mortality was significantly higher among patients with sST2 concentrations above 35 ng/mL (P=0.0213) and among patients with increased concentrations of both sST2 and PCT (P=0.0028).
CONCLUSIONS
sST2 seems to be related to both cardiac dysfunction/failure and severity in sepsis. Measurement of sST2 and PCT in combination would be useful for risk stratification and prognosis prediction in patients with suspected sepsis.

Keyword

Soluble suppression of tumorigenicity 2; Sepsis; Prognosis; Procalcitonin

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Biomarkers/blood
Calcitonin/blood
Enzyme-Linked Immunosorbent Assay
Female
Hospital Mortality
Humans
Interleukin-1 Receptor-Like 1 Protein/*blood
Kaplan-Meier Estimate
Male
Middle Aged
Prognosis
Proportional Hazards Models
Reagent Kits, Diagnostic
Sepsis/*diagnosis/mortality/pathology
Young Adult
Biomarkers
Calcitonin
Interleukin-1 Receptor-Like 1 Protein
Reagent Kits, Diagnostic

Figure

• 

  Fig. 1 Comparison of serum sST2 concentrations according to serum PCT concentrations. (A) Comparison of sST2 concentrations between the 2 groups of PCT concentration below and above the cut-off of 0.5 ng/mL, respectively. The median values (interquartile range) of the 2 groups were 51.3 (32.4-95.0) ng/mL and 184.4 (104.1-273.9) ng/mL, respectively (P<0.0001, Mann-Whitney test). (B) Comparison of sST2 concentrations among the 5 groups of PCT concentration. The median value (interquartile range) of each group was 31.5 (22.0-52.1) ng/mL, 59.7 (37.3-105.6) ng/mL, 150.0 (77.3-238.5) ng/mL, 173.2 (121.7-276.8) ng/mL, and 245.8 (167.4-318.7) ng/mL (P<0.000001, Kruskal-Wallis test). The central box represents the range between the lower and upper quartiles (25th to 75th percentiles) and the middle line shows the median value.Abbreviations: sST2, soluble suppression of tumorigenicity 2; PCT, procalcitonin.

• 

  Fig. 2 Kaplan-Meier survival curves according to serum sST2 and PCT concentrations. (A) The 2 groups of sST2 concentrations above and below the cut-off of 35 ng/mL, respectively, significantly differed in their survival probabilities (P=0.0213, logrank test; HR=2.77 [95% CI, 1.47-5.23]). (B) The 2 groups of PCT concentrations above and below the cut-off of 0.5 ng/mL, respectively, significantly differed in their survival probabilities (P=0.0016, logrank test; HR=2.21 [95% CI, 1.29-3.81]). (C) Survival probability was significantly different among the 4 groups categorized according to sST2 and PCT concentrations (P=0.0028, logrank test). The HR (95% CI) of A vs. D was 3.61 (1.70-7.63), and that of C vs. D was 2.07 (1.15-3.73). (D) In the patients with a group 0 cardiovascular subscore of the SOFA score, survival probability was significantly different between subjects with sST2 concentrations above and below the cut-off of 150 ng/mL, respectively (P=0.0078, logrank test; HR=2.45 [95% CI, 1.09-5.50]). (E) In the patients with a group 0 cardiovascular subscore of the SOFA score, 30-day mortality was significantly different between subjects with sST2 concentrations above and below the cut-off of 150 ng/mL, respectively (P=0.0220, logrank test; HR=2.66 [95% CI, 1.02-7.11]).Abbreviations: sST2, soluble suppression of tumorigenicity 2; PCT, procalcitonin; HR, hazard ratio; CI, confidence interval; SOFA, sepsis-related organ failure assessment.

• 

  Fig. 3 (A) Agreement between sST2 and PCT and (B) distribution of cardiovascular subscores of the SOFA score in the 4 groups categorized according to serum sST2 and PCT concentrations.Abbreviations: sST2, soluble suppression of tumorigenicity 2; PCT, procalcitonin; SOFA, sepsis-related organ failure assessment.

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