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Identification of patients at high likelihood of clinical deterioration is important for guiding decisions about resource allocation and management. We sought to develop a biomarker-based model for 28-day mortality prediction in melioidosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a derivation set (N\u2005=\u2005113) of prospectively enrolled, hospitalized Thai patients with melioidosis, we measured concentrations of interferon-\u03b3, interleukin-1\u03b2, interleukin-6, interleukin-8, interleukin-10, tumor necrosis factor-\u0251, granulocyte-colony stimulating factor, and interleukin-17A. We used least absolute shrinkage and selection operator (LASSO) regression to identify a subset of predictive biomarkers and performed logistic regression and receiver operating characteristic curve analysis to evaluate biomarker-based prediction of 28-day mortality compared with clinical variables. We repeated select analyses in an internal validation set (N\u2005=\u200578) and in a prospectively enrolled external validation set (N\u2005=\u2005161) of hospitalized adults with melioidosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All 8 cytokines were positively associated with 28-day mortality. Of these, interleukin-6 and interleukin-8 were selected by LASSO regression. A model consisting of interleukin-6, interleukin-8, and clinical variables significantly improved 28-day mortality prediction over a model of only clinical variables [AUC (95% confidence interval [CI]): 0.86 (.79\u2013.92) vs 0.78 (.69\u2013.87); P\u2005=\u2005.01]. In both the internal validation set (0.91 [0.84\u20130.97]) and the external validation set (0.81 [0.74\u20130.88]), the combined model including biomarkers significantly improved 28-day mortality prediction over a model limited to clinical variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A 2-biomarker model augments clinical prediction of 28-day mortality in melioidosis.<\/jats:p><\/jats:sec>","DOI":"10.1093\/cid\/ciaa126","type":"journal-article","created":{"date-parts":[[2020,2,6]],"date-time":"2020-02-06T20:10:27Z","timestamp":1581019827000},"page":"821-828","source":"Crossref","is-referenced-by-count":15,"title":["A 2-Biomarker Model Augments Clinical Prediction of Mortality in Melioidosis"],"prefix":"10.1093","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1457-9821","authenticated-orcid":false,"given":"Shelton W","family":"Wright","sequence":"first","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, 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USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6727-3404","authenticated-orcid":false,"given":"Viriya","family":"Hantrakun","sequence":"additional","affiliation":[{"name":"Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina E","family":"Rudd","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prapit","family":"Teparrukkul","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rungnapa","family":"Phunpang","sequence":"additional","affiliation":[{"name":"Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peeraya","family":"Ekchariyawat","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Public Health, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adul","family":"Dulsuk","sequence":"additional","affiliation":[{"name":"Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boonhthanom","family":"Moonmueangsan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Mukdahan Hospital, Mukdahan, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chumpol","family":"Morakot","sequence":"additional","affiliation":[{"name":"Department of Medicine, Mukdahan Hospital, Mukdahan, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ekkachai","family":"Thiansukhon","sequence":"additional","affiliation":[{"name":"Department of Medicine, Udon Thani Hospital, Udon Thani, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7240-5320","authenticated-orcid":false,"given":"Direk","family":"Limmathurotsakul","sequence":"additional","affiliation":[{"name":"Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"},{"name":"Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narisara","family":"Chantratita","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"},{"name":"Mahidol Oxford Tropical Medicine Research Unit, Faculty 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