Pentraxin-3 as a marker of disease severity and risk of death in patients with necrotizing soft tissue infections: a nationwide, prospective, observational study

Marco Bo Hansen, Lars Simon Rasmussen, Peter Garred, Daniel Bidstrup, Martin Bruun Madsen, Ole Hyldegaard, Marco Bo Hansen, Lars Simon Rasmussen, Peter Garred, Daniel Bidstrup, Martin Bruun Madsen, Ole Hyldegaard

Abstract

Background: New biomarkers are needed to assess the severity of necrotizing soft tissue infection (NSTI) at an early stage and to individualize treatment strategies. We assessed pentraxin-3 (PTX3) as a marker of disease severity and risk of death in patients with NSTI.

Methods: We conducted a prospective, observational study in the intensive care unit at Copenhagen University Hospital, where treatment of NSTI is centralized at a national level. We compared PTX3, procalcitonin and C-reactive protein in septic shock versus nonshock patients and in amputated versus nonamputated patients using the Mann-Whitney U test. The prognostic value of the markers for 180-day mortality was assessed using Cox regression analyses.

Results: Patients with NSTI (n = 135) were included over 25 months with up to 2.5-year follow-up; 71% had septic shock, amputation was undertaken in 20% and the 180-day mortality was 27%. Baseline plasma PTX3 level was significantly higher in patients with septic shock (67.3 versus 24.6 ng/mL, p < 0.0001) and in patients who underwent amputation (118.6 versus 43.6 ng/mL, p = 0.019). No significant differences in baseline procalcitonin or C-reactive protein levels were found according to amputation (25.2 versus 7.0 μg/L, p = 0.060 and 202 versus 225 mg/L, p = 0.123), respectively. Baseline PTX3 level above the median was associated with death (p = 0.009, log-rank test) and the univariate Cox regression analysis revealed a significant association between PTX3 level upon admission and 180-day mortality (hazard ratio 2.60 (95% confidence interval 1.28-5.29), p = 0.008). When adjusted for age, sex, chronic disease and Simplified Acute Physiology Score II, no significant association was found.

Conclusions: High PTX3 level is associated with septic shock, amputation and risk of death in patients with NSTI, but it is not an independent predictor of 180-day mortality in this patient group.

Trial registration: ClinicalTrials.gov Identifier: NCT02180906. Date of registration: June 29, 2014.

Figures

Fig. 1
Fig. 1
Flow chart of patient inclusion. NSTI Necrotizing soft tissue infection
Fig. 2
Fig. 2
Pentraxin-3 level upon admission (baseline) and for the following 3 days in a septic shock versus nonshock, b amputation versus no amputation, c 180-day mortality and d NSTI versus control. NSTI Necrotizing soft tissue infection, PTX3 Pentraxin-3
Fig. 3
Fig. 3
Kaplan-Meier curves of long-term mortality up to 2.5 years in patients with necrotizing soft tissue infections stratified by median plasma PTX3 level (>52.4 ng/mL). PTX3 Pentraxin-3
Fig. 4
Fig. 4
Receiver operating characteristic curve of 180-day mortality in patients with necrotizing soft tissue infections for the inflammatory biomarkers. CRP C-reactive protein, PTX3 Pentraxin-3

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