Blood lactate/ATP ratio, as an alarm index and real-time biomarker in critical illness.

<h4>Objective</h4>The acute physiology, age and chronic health evaluation (APACHE) II score and other related scores have been used for evaluation of illness severity in the intensive care unit (ICU), but there is still a need for real-time and sensitive prognostic biomarkers. Recently,...

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Autores principales: Junji Chida, Rie Ono, Kazuhiko Yamane, Mineyoshi Hiyoshi, Masaji Nishimura, Mutsuo Onodera, Emiko Nakataki, Koichi Shichijo, Masatami Matushita, Hiroshi Kido
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Publicado: Public Library of Science (PLoS) 2013
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spelling oai:doaj.org-article:e03fcf37e94c4ea08296d5efdec0cf592021-11-18T07:50:27ZBlood lactate/ATP ratio, as an alarm index and real-time biomarker in critical illness.1932-620310.1371/journal.pone.0060561https://doaj.org/article/e03fcf37e94c4ea08296d5efdec0cf592013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23577122/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Objective</h4>The acute physiology, age and chronic health evaluation (APACHE) II score and other related scores have been used for evaluation of illness severity in the intensive care unit (ICU), but there is still a need for real-time and sensitive prognostic biomarkers. Recently, alarmins from damaged tissues have been reported as alarm-signaling molecules. Although ATP is a member of the alarmins and its depletion in tissues closely correlates with multiple-organ failure, blood ATP level has not been evaluated in critical illness. To identify real-time prognostic biomarker of critical illness, we measured blood ATP levels and the lactate/ATP ratio (ATP-lactate energy risk score, A-LES) in critically ill patients.<h4>Methods and results</h4>Blood samples were collected from 42 consecutive critically ill ICU patients and 155 healthy subjects. The prognostic values of blood ATP levels and A-LES were compared with APACHE II score. The mean ATP level (SD) in healthy subjects was 0.62 (0.19) mM with no significant age or gender differences. The median ATP level in severely ill patients at ICU admission was significantly low at 0.31 mM (interquartile range 0.25 to 0.44) than the level in moderately ill patient at 0.56 mM (0.38 to 0.70) (P<0.01). Assessment with ATP was further corrected by lactate and expressed as A-LES. The median A-LES was 2.7 (2.1 to 3.3) in patients with satisfactory outcome at discharge but was significantly higher in non-survivors at 38.9 (21.0 to 67.9) (P<0.01). Receiver operating characteristic analysis indicated that measurement of blood ATP and A-LES at ICU admission are as useful as APACHE II score for prediction of mortality.<h4>Conclusion</h4>Blood ATP levels and A-LES are sensitive prognostic biomarkers of mortality at ICU admission. In addition, A-LES provided further real-time evaluation score of illness severity during ICU stay particularly for critically ill patients with APACHE II scores of ≥20.0.Junji ChidaRie OnoKazuhiko YamaneMineyoshi HiyoshiMasaji NishimuraMutsuo OnoderaEmiko NakatakiKoichi ShichijoMasatami MatushitaHiroshi KidoPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 4, p e60561 (2013)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Junji Chida
Rie Ono
Kazuhiko Yamane
Mineyoshi Hiyoshi
Masaji Nishimura
Mutsuo Onodera
Emiko Nakataki
Koichi Shichijo
Masatami Matushita
Hiroshi Kido
Blood lactate/ATP ratio, as an alarm index and real-time biomarker in critical illness.
description <h4>Objective</h4>The acute physiology, age and chronic health evaluation (APACHE) II score and other related scores have been used for evaluation of illness severity in the intensive care unit (ICU), but there is still a need for real-time and sensitive prognostic biomarkers. Recently, alarmins from damaged tissues have been reported as alarm-signaling molecules. Although ATP is a member of the alarmins and its depletion in tissues closely correlates with multiple-organ failure, blood ATP level has not been evaluated in critical illness. To identify real-time prognostic biomarker of critical illness, we measured blood ATP levels and the lactate/ATP ratio (ATP-lactate energy risk score, A-LES) in critically ill patients.<h4>Methods and results</h4>Blood samples were collected from 42 consecutive critically ill ICU patients and 155 healthy subjects. The prognostic values of blood ATP levels and A-LES were compared with APACHE II score. The mean ATP level (SD) in healthy subjects was 0.62 (0.19) mM with no significant age or gender differences. The median ATP level in severely ill patients at ICU admission was significantly low at 0.31 mM (interquartile range 0.25 to 0.44) than the level in moderately ill patient at 0.56 mM (0.38 to 0.70) (P<0.01). Assessment with ATP was further corrected by lactate and expressed as A-LES. The median A-LES was 2.7 (2.1 to 3.3) in patients with satisfactory outcome at discharge but was significantly higher in non-survivors at 38.9 (21.0 to 67.9) (P<0.01). Receiver operating characteristic analysis indicated that measurement of blood ATP and A-LES at ICU admission are as useful as APACHE II score for prediction of mortality.<h4>Conclusion</h4>Blood ATP levels and A-LES are sensitive prognostic biomarkers of mortality at ICU admission. In addition, A-LES provided further real-time evaluation score of illness severity during ICU stay particularly for critically ill patients with APACHE II scores of ≥20.0.
format article
author Junji Chida
Rie Ono
Kazuhiko Yamane
Mineyoshi Hiyoshi
Masaji Nishimura
Mutsuo Onodera
Emiko Nakataki
Koichi Shichijo
Masatami Matushita
Hiroshi Kido
author_facet Junji Chida
Rie Ono
Kazuhiko Yamane
Mineyoshi Hiyoshi
Masaji Nishimura
Mutsuo Onodera
Emiko Nakataki
Koichi Shichijo
Masatami Matushita
Hiroshi Kido
author_sort Junji Chida
title Blood lactate/ATP ratio, as an alarm index and real-time biomarker in critical illness.
title_short Blood lactate/ATP ratio, as an alarm index and real-time biomarker in critical illness.
title_full Blood lactate/ATP ratio, as an alarm index and real-time biomarker in critical illness.
title_fullStr Blood lactate/ATP ratio, as an alarm index and real-time biomarker in critical illness.
title_full_unstemmed Blood lactate/ATP ratio, as an alarm index and real-time biomarker in critical illness.
title_sort blood lactate/atp ratio, as an alarm index and real-time biomarker in critical illness.
publisher Public Library of Science (PLoS)
publishDate 2013
url https://doaj.org/article/e03fcf37e94c4ea08296d5efdec0cf59
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