Diagnostic value and prognostic evaluation of Presepsin for sepsis in an emergency department

Bo Liu, Yun-Xia Chen, Qin Yin, Yun-Zhou Zhao, Chun-Sheng Li, Bo Liu, Yun-Xia Chen, Qin Yin, Yun-Zhou Zhao, Chun-Sheng Li

Abstract

Introduction: Presepsin levels are known to be increased in sepsis. The aim of this study was to evaluate the early diagnostic and prognostic value of Presepsin compared with procalcitonin (PCT), Mortality in Emergency Department Sepsis (MEDS) score and Acute Physiology and Chronic Health Evaluation II (APACHE II) score in septic patients in an emergency department (ED) and to investigate Presepsin as a new biomarker of sepsis.

Methods: This study enrolled 859 consecutive patients with at least two diagnostic criteria for systemic inflammatory response syndrome (SIRS) who were admitted to Beijing Chao-yang Hospital ED from December 2011 to October 2012, and 100 age-matched healthy controls. Patients were stratified into four groups: SIRS, sepsis, severe sepsis, and septic shock. Plasma Presepsin and serum PCT were measured, and MEDS score and APACHE II score were calculated at enrollment. Comparisons were analyzed using the Kruskal-Wallis and Mann-Whitney U tests.

Results: On admission, the median levels of plasma Presepsin increased with sepsis severity. The areas under the receiver operating characteristic (AUC) curves of Presepsin were greater than those of PCT in diagnosing sepsis, and predicting severe sepsis and septic shock. The AUC of Presepsin for predicting 28-day mortality in septic patients was slightly lower than that of PCT, MEDS score and APACHE II score. The AUC of a combination of Presepsin and MEDS score or APACHE II score was significantly higher than that of MEDS score or APACHE II score alone in predicting severe sepsis, and was markedly higher than that of Presepsin alone in predicting septic shock and 28-day mortality in septic patients, respectively. Plasma Presepsin levels in septic patients were significantly higher in non-survivors than in survivors at 28 days' follow-up. Presepsin, MEDS score and APACHE II score were found to be independent predictors of severe sepsis, septic shock and 28-day mortality in septic patients. The levels of plasma Presepsin were positively correlated with PCT, MEDS score and APACHE II score in every septic group.

Conclusion: Presepsin is a valuable biomarker for early diagnosis of sepsis, risk stratification, and evaluation of prognosis in septic patients in the ED.

Figures

Figure 1
Figure 1
Plasma presepsin levels in healthy control individuals, and patients with SIRS, sepsis, severe sepsis and septic shock at emergency department admission. Columns represent median presepsin levels. Numbers of samples are indicated in parentheses. SIRS, systemic inflammatory response syndrome.
Figure 2
Figure 2
Serum procalcitonin levels in healthy control individuals, and patients with SIRS, sepsis, severe sepsis and septic shock at emergency department admission. Columns represent median procalcitonin (PCT) levels. Numbers of samples are indicated in parentheses. SIRS, systemic inflammatory response syndrome.
Figure 3
Figure 3
MEDS score in patients with SIRS, sepsis, severe sepsis and septic shock at emergency department admission. Columns represent median Mortality in Emergency Department Sepsis (MEDS) score levels. Numbers of samples are indicated in parentheses. SIRS, systemic inflammatory response syndrome.
Figure 4
Figure 4
APACHE II score in patients with SIRS, sepsis, severe sepsis and septic shock at emergency department admission. Columns represent median Acute Physiology and Chronic Health Evaluation (APACHE) II score levels. Numbers of samples are indicated in parentheses. SIRS, systemic inflammatory response syndrome.
Figure 5
Figure 5
Receiver operating characteristic curves of presepsin and procalcitonin for diagnosis of sepsis. Areas under the receiver operating characteristic (ROC) curve: presepsin (blue line), 0.820 (95% confidence interval: 0.784 to 0.856), P < 0.0001; and procalcitonin (PCT; green line), 0.724 (95% confidence interval: 0.680 to 0.769), P <0.0001.
Figure 6
Figure 6
Receiver operating characteristic curves of presepsin, procalcitonin, MEDS score and APACHE II score for predicting severe sepsis in septic patients. Areas under the receiver operating characteristic (ROC) curves: presepsin (blue line), 0.840 (95% confidence interval (CI): 0.809 to 0.872), P <0.0001; procalcitonin (PCT; green line), 0.741 (95% CI: 0.703 to 0.779), P <0.0001; Mortality in Emergency Department Sepsis (MEDS) score (brown line), 0.818 (95% CI: 0.785 to 0.851), P <0.0001; Acute Physiology and Chronic Health Evaluation (APACHE) II score (purple line), 0.744 (95% CI: 0.706 to 0.782), P <0.0001; presepsin in combination with MEDS score (yellow line), 0.875 (95% CI: 0.848 to 0.901), P <0.0001; and presepsin in combination with APACHE II score (pink line), 0.858 (95% CI: 0.829 to 0.887), P <0.0001.
Figure 7
Figure 7
Presepsin levels at admission in surviving and nonsurviving groups of septic patients at 28-day follow-up. Lines denote median values, boxes represent 25th to 75th percentiles and whiskers indicate the range.

References

    1. Protti A, Singer M. Bench-to-bedside review: potential strategies to protect or reverse mitochondrial dysfunction in sepsis-induced organ failure. Crit Care. 2006;17:228. doi: 10.1186/cc5014.
    1. Wright SD, Ramos RA, Tobias PS, Ulevitch RJ, Mathison JC. CD14, a receptor for complexes of lipopolysaccharide (LPS) and LPS binding protein. Science. 1990;17:1431–1433. doi: 10.1126/science.1698311.
    1. Shirakawa K, Naitou K, Hirose J, Takahashi T, Furusako S. Presepsisn (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;17:937–939.
    1. Yaegashi Y, Shirakawa K, Sato N, Suzuki Y, Kojika M, Imai S, Takahashi G, Miyata M, Furusako S, Endo S. Evaluation of a newly identified soluble CD14 subtype as a marker for sepsis. J Infect Chemother. 2005;17:234–238. doi: 10.1007/s10156-005-0400-4.
    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. Okamura Y, Yokoi H. Development of a point-of-care assay system for measurement of presepsin (sCD14-ST) Clin Chim Acta. 2011;17:2157–2161. doi: 10.1016/j.cca.2011.07.024.
    1. Endo S, Yaegashi Y, Sato N, Suzuki Y, Ogawa M, Kojika M. Comparative study of soluble CD14 and soluble CD14-subtype in sepsis. Med Postgrad. 2006;17:381–385.
    1. Miyata M, Sato N, Takahashi G, Takahashi M, Endo S. The utility of the soluble CD-14-subtype for diagnosis of sepsis, the examination of the simple diagnostic kit. J Iwate Med Assoc. 2007;17:325–331.
    1. Endo S, Suzuki Y, Takahashi G, Shozushima T, Ishikura H, Murai A, Nishida T, Irie Y, Miura M, Iguchi H, Fukui Y, Tanaka K, Nojima T, Okamura Y. Usefulness of presepsin in the diagnosis of sepsis in a multicenter prospective study. J Infect Chemother. 2012;17:891–897. doi: 10.1007/s10156-012-0435-2.
    1. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G. International Sepsis Definitions Conference. SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Intensive Care Med. 2001;17(29):530–538.
    1. Calandra T, Cohen J. The international sepsis forum consensus conference on definitions of infection in the intensive care unit. Crit Care Med. 2005;17:1538–1548. doi: 10.1097/01.CCM.0000168253.91200.83.
    1. Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, Whitley RJ. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;17:1267–1284. doi: 10.1086/425368.
    1. Kurihara T, Yanagida A, Yokoi H, Koyata A, Matsuya T, Ogawa J, Okamura Y, Miyamoto D. Evaluation of cardiac assays on a benchtop chemiluminescent enzyme immunoassay analyzer, PATHFAST. Anal Biochem. 2008;17:144–146. doi: 10.1016/j.ab.2007.12.030.
    1. Shapiro NI, Wolfe RE, Moore RB, Smith E, Burdick E, Bates DW. Mortality in emergency department sepsis (MEDS) scores: a prospectively derived and validated clinical prediction rule. Crit Care Med. 2003;17:670–675. doi: 10.1097/01.CCM.0000054867.01688.D1.
    1. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II:a severity of disease classification system. Crit Care Med. 1985;17:818–829. doi: 10.1097/00003246-198510000-00009.
    1. Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;17:1546–1554. doi: 10.1056/NEJMoa022139.
    1. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome and associated costs of care. Crit Care Med. 2001;17:1303–1310. doi: 10.1097/00003246-200107000-00002.
    1. Mussap M, Noto A, Fravega M, Fanos V. Soluble CD14 subtype presepsin (sCD14-ST) and lipopolysaccharide binding protein (LBP) in neonatal sepsis: new clinical and analytical perspectives for two old biomarkers. J Matern Fetal Neonatal Med. 2011;17:12–14.
    1. Naitoh K, Shirakawa K, Hirose J, Nakamura M, Takeuchi T, Hosaka Y, Furusako S. The new sepsis marker, sCD14-ST (PRESEPSIN): induction mechanism in the rabbit sepsis models. Crit Care. 2010;17:P19.
    1. Schuetz P, Christ-Crain M, Mueller B. Procalcitonin and other biomarkers for the assessment of disease severity and guidance of treatment in bacterial infections. Adv Sepsis. 2008;17:82–89.
    1. Naeini AE, Montazerolghaem S. Procalcitonin marker for sepsis diagnosis. Evaluating a rapid immuno-chromatografi c test. Saudi Med J. 2006;17:422–424.
    1. Oshita H, Sakurai J, Kamitsuna M. Semi-quantitative procalcitonin test for the diagnosis of bacterial infection: clinical use and experience in Japan. J Microbiol Immunol Infect. 2010;17:222–227. doi: 10.1016/S1684-1182(10)60035-7.
    1. Schuetz P, Chiappa V, Briel M, Greenwald JL. Procalcitonin algorithms for antibiotic therapy decisions. A systematic review of randomized controlled trials and recommendations for clinical algorithms. Arch Intern Med. 2011;17:1322–1331. doi: 10.1001/archinternmed.2011.318.
    1. Schuetz P, Briel M, Christ-Crain M, Stolz D, Bouadma L, Wolff M, Luyt CE, Chastre J, Tubach F, Kristoffersen KB, Wei L, Burkhardt O, Welte T, Schroeder S, Nobre V, Tamm M, Bhatnagar N, Bucher HC, Mueller B. Procalcitonin to guide initiation and duration of antibiotic treatment in acute respiratory infections: an individual patient data meta-analysis. Clin Infect Dis. 2012;17:651–662. doi: 10.1093/cid/cis464.
    1. Christ-Crain M, Müller B. Procalcitonin in bacterial infections – hype, hope, more or less? Swiss Med Wkly. 2005;17:451–456.
    1. Venkataraman R, Kellum JA. Sepsis: update in the management. Adv Chronic Kidney Dis. 2013;17:6–13. doi: 10.1053/j.ackd.2012.10.013.
    1. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb SA, Beale RJ, Vincent JL, Moreno R. Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock. Crit Care Med. 2013;17:580–637. doi: 10.1097/CCM.0b013e31827e83af.
    1. Ruiz-Alvarez MJ, García-Valdecasas S, de Pablo R, Sanchez García M, Coca C, Groeneveld TW, Roos A, Daha MR, Arribas I. Diagnostic efficacy and prognostic value of serum procalcitonin concentration in patients with suspected sepsis. J Intensive Care Med. 2009;17:63–71.

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