Key result
The admission Ang-2/Ang-1 ratio was a strong predictor of 28-day mortality in patients with early sepsis, with an AUC of 0.845, significantly outperforming procalcitonin.
Why the study?
Do Ang-2/Ang-1 and Ang-1/Tie-2 ratios improve the prediction of 28-day mortality compared to PCT and MEDS score in patients with early sepsis?
Observational (n=495)
No
Do Ang-2/Ang-1 and Ang-1/Tie-2 ratios improve the prediction of 28-day mortality compared to PCT and MEDS score in patients with early sepsis?
Ang-2/Ang-1 and Ang-1/Tie-2 ratios are valuable biomarkers for risk stratification and predicting 28-day mortality in patients with early sepsis in the emergency department.
Answers are grounded in this paper and cite their sources.
Ratios may aid early sepsis mortality prediction over PCT/MEDS; hypothesis-generating pending prospective validation.
INTRODUCTION: This study was performed to assess the early diagnostic, risk stratification, and prognostic value of the angiopoietin-2/angiopoietin-1 ratio (Ang-2/Ang-1) and angiopoietin-1/tyrosine kinase with immunoglobulin-like loop epidermal growth factor homology domain 2 ratio (Ang-1/Tie-2) and to compare these factors with procalcitonin (PCT) and the Mortality in Emergency Department Sepsis (MEDS) score in patients with early sepsis in the emergency department (ED). METHODS: Consecutive patients with sepsis (n = 440) were enrolled in this study. They fulfilled the systemic inflammatory response syndrome (SIRS) criteria and were admitted to the ED of Beijing Chao-yang Hospital between August 2014 and February 2015. The control group consisted of 55 healthy blood donors. The patients were categorized into four groups: SIRS, sepsis, severe sepsis, and septic shock. Serum Ang-1, Ang-2, Tie-2, and PCT were measured, and the MEDS score was calculated upon ED arrival. The prognostic values of Ang-2/Ang-1, Ang-1/Tie-2, Ang-1, Ang-2, and Tie-2 were compared with the PCT and MEDS scores. All patients were followed for 28 days. RESULTS: Upon admission, the median levels of the serum Ang-2 level and Ang-2/Ang-1 ratio increased and the serum Ang-1 levels and Ang-1/Tie-2 ratios decreased with the severity of sepsis. The areas under the receiver operating characteristic curves of the Ang-2/Ang-1 and Ang-1/Tie-2 ratios were greater than those of the Ang-1, Ang-2, and PCT levels and MEDS scores in the diagnosis and prediction of 28-day mortality due to sepsis. Ang-2/Ang-1 was significantly higher and Ang-1/Tie-2 was significantly lower in nonsurvivors than in survivors at the 28-day follow-up examination. Ang-2/Ang-1, Ang-1/Tie-2, and MEDS score were found to be independent predictors of 28-day mortality in patients with sepsis. The levels of serum Ang-1, Ang-2, and Tie-2 were positively correlated with each other. The ratios of Ang-2/Ang-1 and Ang-1/Tie-2 were positively and negatively correlated, respectively, with the MEDS score in every septic group. CONCLUSIONS: The Ang-2/Ang-1 and Ang-1/Tie-2 ratios are valuable for risk stratification in patients with sepsis and are associated with the poor clinical outcome of early sepsis in the ED.
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Fang et al. (2015) conducted an observational in Early sepsis (n=495). Ang-2/Ang-1 ratio vs. Procalcitonin (PCT) was evaluated on Prediction of 28-day mortality (AUC) (AUC 0.845, 95% CI 0.810-0.880, p=<0.05). The admission Ang-2/Ang-1 ratio was a strong predictor of 28-day mortality in patients with early sepsis, with an AUC of 0.845, significantly outperforming procalcitonin.
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