Diagnostic and prognostic value of soluble CD14 subtype (Presepsin) for sepsis and community-acquired pneumonia in ICU patients

Kada Klouche, Jean Paul Cristol, Julie Devin, Vincent Gilles, Nils Kuster, Romaric Larcher, Laurent Amigues, Philippe Corne, Olivier Jonquet, Anne Marie Dupuy, Kada Klouche, Jean Paul Cristol, Julie Devin, Vincent Gilles, Nils Kuster, Romaric Larcher, Laurent Amigues, Philippe Corne, Olivier Jonquet, Anne Marie Dupuy

Abstract

Background: The soluble CD14 subtype, Presepsin, appears to be an accurate sepsis diagnostic marker, but data from intensive care units (ICUs) are scarce. This study was conducted to evaluate the diagnostic and prognostic value of Presepsin in ICU patients with severe sepsis (SS), septic shock (SSh) and severe community-acquired pneumonia (sCAP).

Methods: Presepsin and procalcitonin (PCT) levels were determined for patients at admission to ICU. Four groups have been differentiated: (1) absence or (2) presence of systemic inflammatory response syndrome, (3) SS or (4) SSh; and 2 groups, among the patients admitted for acute respiratory failure: absence or presence of sCAP. Biomarkers were tested for diagnosis of SS, SSh and sCAP and for prediction of ICU mortality.

Results: One hundred and forty-four patients were included: 44 SS and 56 SSh. Plasma levels of Presepsin and PCT were significantly higher in septic than in non-septic patients and in SSh as compared to others. The sepsis diagnostic accuracy of Presepsin was not superior to that of PCT (AUC: 0.75 vs 0.80). In the 72/144 patients admitted for acute respiratory failure, the capability of Presepsin to diagnose sCAP was significantly better than PCT. Presepsin levels were also predictive of ICU mortality in sepsis and in sCAP patients.

Conclusion: Plasma levels of Presepsin were useful for the diagnosis of SS, SSh and sCAP and may predict ICU mortality in these patients.

Keywords: Community-acquired pneumonia; Diagnosis; Presepsin; Procalcitonin; Prognosis; Septic shock; Severe sepsis.

Figures

Fig. 1
Fig. 1
Flowchart for the study population. SIRS systemic inflammatory systemic response, ARF acute respiratory failure, NIRF non-infectious respiratory failure, sCAP severe community-acquired pneumonia
Fig. 2
Fig. 2
Comparison of Presepsin and PCT levels at ICU admission in all patients (a, b, respectively) and in the 72 patients with acute respiratory failure: infectious versus non-infectious origin (c, d, respectively). SIRS systemic inflammatory systemic response, NSIRS non-SIRS, S Sepsis severe sepsis, S shock septic shock, NIRF non-infectious respiratory failure
Fig. 3
Fig. 3
Receiver operating characteristic (ROC) for Presepsin, PCT, SAPS II and SOFA for diagnosis of sepsis (severe sepsis or septic shock) in all patients (a) and for diagnosis of pneumonia (infectious respiratory failure) in patients admitted for acute respiratory failure (b). SAPS simplified acute physiology score, SOFA sequential organ failure assessment score, PCT procalcitonin
Fig. 4
Fig. 4
Kaplan–Meier graph showing correlation between plasma levels of Presepsin and survival in septic critically ill patients (a, b) and in critically ill patients with pneumonia (c, d). Survival curves according to the quartile of Presepsin (a) and to the cutoff of Presepsin (b) in septic critically ill patients, and in patients with pneumonia [according to the quartile of Presepsin (c) and to the cutoff of Presepsin (d)]. p values are given in each figure

References

    1. Vincent J-L, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. 2006;34:344–353. doi: 10.1097/01.CCM.0000194725.48928.3A.
    1. Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med. 2013;369:840–851. doi: 10.1056/NEJMra1208623.
    1. Pierrakos C, Vincent J-L. Sepsis biomarkers: a review. Crit Care. 2010;14:R15. doi: 10.1186/cc8872.
    1. Wacker C, Prkno A, Brunkhorst FM, Schlattmann P. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13:426–435. doi: 10.1016/S1473-3099(12)70323-7.
    1. Kibe S, Adams K, Barlow G. Diagnostic and prognostic biomarkers of sepsis in critical care. J Antimicrob Chemother. 2011;66(Suppl 2):ii33–ii40.
    1. Yaegashi Y, Shirakawa K, Sato N, Suzuki Y, Kojika M, Imai S, et al. Evaluation of a newly identified soluble CD14 subtype as a marker for sepsis. J Infect Chemother. 2005;11:234–238. doi: 10.1007/s10156-005-0400-4.
    1. Behnes M, Bertsch T, Lepiorz D, Lang S, Trinkmann F, Brueckmann M, et al. Diagnostic and prognostic utility of soluble CD14 subtype (presepsin) for severe sepsis and septic shock during the first week of intensive care treatment. Crit Care. 2014;18(5):507. doi: 10.1186/s13054-014-0507-z.
    1. Shozushima T, Takahashi G, Matsumoto N, Kojika M, Okamura Y, Endo S. Usefulness of presepsin (sCD14-ST) measurements as a marker for the diagnosis and severity of sepsis that satisfied diagnostic criteria of systemic inflammatory response syndrome. J Infect Chemother. 2011;17:764–769. doi: 10.1007/s10156-011-0254-x.
    1. Endo S, Suzuki Y, Takahashi G, Shozushima T, Ishikura H, Murai A, et al. Usefulness of presepsin in the diagnosis of sepsis in a multicenter prospective study. J Infect Chemother. 2012;18:891–897. doi: 10.1007/s10156-012-0435-2.
    1. Liu B, Chen Y-X, Yin Q, Zhao Y-Z, Li C-S. Diagnostic value and prognostic evaluation of Presepsin for sepsis in an emergency department. Crit Care. 2013;17(5):R244. doi: 10.1186/cc13070.
    1. Carpio R, Zapata J, Spanuth E, Hess G. Utility of presepsin (sCD14-ST) as a diagnostic and prognostic marker of sepsis in the emergency department. Clin Chim Acta. 2015;450:169–175. doi: 10.1016/j.cca.2015.08.013.
    1. Romualdo LG, Torrella PE, González MV, Sánchez RJ, Holgado AH, Freire AO, Acebes SR, Otón MD. Diagnostic accuracy of presepsin (soluble CD14 subtype) for prediction of bacteremia in patients with systemic inflammatory response syndrome in the Emergency Department. Clin Biochem. 2014;47(7–8):505–508. doi: 10.1016/j.clinbiochem.2014.02.011.
    1. Ulla M, Pizzolato E, Lucchiari M, et al. Diagnostic and prognostic value of presepsin in the management of sepsis in the emergency department: a multicenter prospective study. Crit Care. 2013;17(4):R168. doi: 10.1186/cc12847.
    1. Liu B, Yin Q, Chen YX, Zhao YZ, Li CS. Role of Presepsin (sCD14-ST) and the CURB65 scoring system in predicting severity and outcome of community-acquired pneumonia in an emergency department. Respir Med. 2014;108(8):1204–1213. doi: 10.1016/j.rmed.2014.05.005.
    1. Wu J, Hu L, Zhang G, Wu F, He T. Accuracy of presepsin in sepsis diagnosis: a systematic review and meta-analysis. PLoS ONE. 2015;10(7):e0133057. doi: 10.1371/journal.pone.0133057.
    1. Zhang X, Liu D, Liu Y, Wang R, Xie L. The accuracy of presepsin (sCD14-ST) for the diagnosis of sepsis in adults: a meta-analysis. Crit Care. 2015;19:323. doi: 10.1186/s13054-015-1032-4.
    1. Okamura Y, Yokoi H. Development of a point-of-care assay system for measurement of presepsin (sCD14-ST) Clin Chim Acta. 2011;412:2157–2161. doi: 10.1016/j.cca.2011.07.024.
    1. Le Gall JR, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270:2957–2963. doi: 10.1001/jama.1993.03510240069035.
    1. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22:707–710. doi: 10.1007/BF01709751.
    1. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101:1644–1655. doi: 10.1378/chest.101.6.1644.
    1. Niederman MS, Mandell LA, Anzueto A, Bass JB, Broughton WA, Campbell GD, et al. Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med. 2001;163:1730–1754. doi: 10.1164/ajrccm.163.7.at1010.
    1. Kumar A, Ellis P, Arabi Y, Roberts D, Light B, Parrillo JE, et al. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest. 2009;136:1237–1248. doi: 10.1378/chest.09-0087.
    1. Landmann R, Zimmerli W, Sansano S, Link S, Hahn A, Glauser MP, et al. Increased circulating soluble CD14 is associated with high mortality in gram-negative septic shock. J Infect Dis. 1995;171:639–644. doi: 10.1093/infdis/171.3.639.
    1. Shirakawa K, Naitou K, Hirose J, Takahashi T, Furusako S. Presepsin (sCD14-ST): development and evaluation of one-step ELISA with a new standard that is similar to the form of presepsin in septic patients. Clin Chem Lab Med. 2011;49:937–939. doi: 10.1515/CCLM.2011.145.
    1. Bufler P, Stiegler G, Schuchmann M, et al. Soluble lipopolysaccharide receptor (CD14) is released via two different mechanisms from human monocytes and CD14 transfectants. Eur J Immunol. 1995;25:604–610. doi: 10.1002/eji.1830250244.
    1. Dandona P, Nix D, Wilson MF, Aljada A, Love J, Assicot M, et al. Procalcitonin increase after endotoxin injection in normal subjects. J Clin Endocrinol Metab. 1994;79:1605–1608.
    1. Nakamura M, Takeuchi T, Naito K, Shirakawa K, Hosaka Y, Yamasaki F, et al. Early elevation of plasma soluble CD14 subtype, a novel biomarker for sepsis, in a rabbit cecal ligation and puncture model. Crit Care. 2008;12:P194. doi: 10.1186/cc6415.
    1. Enguix-Armada A, Escobar-Conesa R, La Torre AG, De La Torre-Prados MV. Usefulness of several biomarkers in the management of septic patients: C-reactive protein, procalcitonin, presepsin and mid-regional pro-adrenomedullin. Clin Chem Lab Med. 2016;54(1):163–168. doi: 10.1515/cclm-2015-0243.
    1. Masson S, Caironi P, Spanuth E, Thomae R, Panigada M, Sangiorgi G, et al. Presepsin (soluble CD14 subtype) and procalcitonin levels for mortality prediction in sepsis: data from the Albumin Italian Outcome Sepsis trial. Crit Care. 2014;18(1):R6. doi: 10.1186/cc13183.
    1. Masson S, Caironi P, Fanizza C, Thomae R, Bernasconi R, Noto A, et al. Circulating presepsin (soluble CD14 subtype) as a marker of host response in patients with severe sepsis or septic shock: data from the multicenter, randomized ALBIOS trial. Intensive Care Med. 2015;41:12–20. doi: 10.1007/s00134-014-3514-2.
    1. Polverino E, Torres Marti A. Community-acquired pneumonia. Minerva Anestesiol. 2011;77:196–211.
    1. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336:243–250. doi: 10.1056/NEJM199701233360402.
    1. Schuetz P, Briel M, Mueller B. Clinical outcomes associated with procalcitonin algorithms to guide antibiotic therapy in respiratory tract infections. JAMA. 2013;309:717–718. doi: 10.1001/jama.2013.697.
    1. Schuetz P, Litke A, Albrich WC, Mueller B. Blood biomarkers for personalized treatment and patient management decisions in community-acquired pneumonia. Curr Opin Infect Dis. 2013;26:159–167.
    1. Müller F, Christ-Crain M, Bregenzer T, Krause M, Zimmerli W, Mueller B, et al. Procalcitonin levels predict bacteremia in patients with community-acquired pneumonia: a prospective cohort trial. Chest. 2010;138:121–129. doi: 10.1378/chest.09-2920.
    1. Bafadhel M, Clark TW, Reid C, Medina M, Batham S, Barer MR, et al. Procalcitonin and C-reactive protein in hospitalized adult patients with community-acquired pneumonia or exacerbation of asthma or COPD. Chest. 2011;139:1410–1418. doi: 10.1378/chest.10-1747.
    1. Horie M, Ugajin M, Suzuki M, Noguchi S, Tanaka W, Yoshihara H, et al. Diagnostic and prognostic value of procalcitonin in community-acquired pneumonia. Am J Med Sci. 2012;343:30–35. doi: 10.1097/MAJ.0b013e31821d33ef.
    1. Tamura M, Watanabe M, Nakajima A, et al. Serial quantification of procalcitonin (PCT) predicts clinical outcome and prognosis in patients with community-acquired pneumonia (CAP) J Infect Chemother. 2014;20:97–103. doi: 10.1016/j.jiac.2013.09.005.
    1. Nagata T, Yasuda Y, Ando M, Abe T, Katsumo T, Kato S, Tsuboi N, et al. Clinical impact of kidney function on Presepsin levels. PLoS ONE. 2015;10(6):e0129159. doi: 10.1371/journal.pone.0129159.
    1. Chenevier-Gobeaux C, Borderie D, Weiss N, Mallet-Coste T, Claessens Y-E. Presepsin (sCD14-ST), an innate immune response marker in sepsis. Clin Chim Acta. 2015;450:97–103. doi: 10.1016/j.cca.2015.06.026.
    1. Zheng Z, Jiang L, Ye L, Gao Y, Tang L, Zhang M. The accuracy of presepsin for the diagnosis of sepsis from SIRS: a systematic review and metaanalysis. Ann Intensive Care. 2015;5:48. doi: 10.1186/s13613-015-0089-1.

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