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Wu W, Wang C, Zhang Y, Xie Y, Li X. Analysis of the correlation between the group-based trajectory modeling of serum osmolality and prognosis in patients with sepsis-associated encephalopathy at 72 h after admission. BMC Infect Dis 2025; 25:106. [PMID: 39849352 PMCID: PMC11755937 DOI: 10.1186/s12879-025-10482-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Accepted: 01/10/2025] [Indexed: 01/25/2025] Open
Abstract
BACKGROUND This study aimed to identify distinct trajectories of serum osmolality within the first 72 h for patients with sepsis-associated encephalopathy (SAE) in the MIMIC-IV and eICU-CRD databases and assess their impact on mortality and adverse clinical outcomes. METHODS In this retrospective cohort study, patients with SAE from the MIMIC-IV database were included. Group-based trajectory modeling (GBTM) was used to categorize distinct patterns of serum osmolality changes over 72 h in ICU patients. Differences in survival across the trajectory groups were compared using Kaplan-Meier (K-M) survival curves. RESULTS A total of 11,376 patients with SAE were included in the analysis, with a median age of 65.6 ± 16.5 years. The in-hospital mortality rate at 30 days was 12.8%. Based on model-defined criteria, three distinct osmolality trajectory groups were identified: Group 1 (59.6%), Group 2 (36.4%), and Group 3 (4.0%). Kaplan-Meier survival analysis indicated that patients with relatively lower serum osmolality within the normal range (Group 1) had a lower 30-day mortality rate compared to those in the other groups (Group 2 and 3). Subgroup analysis demonstrated significant interactions (P < 0.05) between osmolality trajectories and covariates such as the Sequential Organ Failure Assessment (SOFA), vasopressor use and renal replacement therapy (RRT). CONCLUSION Identifying distinct serum osmolality trajectories may help recognize SAE patient subgroups with varying risks of adverse outcomes, providing clinically meaningful stratification.
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Affiliation(s)
- Wentao Wu
- Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China
- Department of Emergency and Critical Care Medicine, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Chen Wang
- Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China
- Department of Emergency and Critical Care Medicine, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Yuhua Zhang
- Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China
- Department of Emergency and Critical Care Medicine, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Yongpeng Xie
- Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China
- Department of Emergency and Critical Care Medicine, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Xiaomin Li
- Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China.
- Department of Emergency and Critical Care Medicine, The First People's Hospital of Lianyungang, Lianyungang, China.
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Imai Y, Tanaka R, Matsuo K, Yoshimoto H, Asakuma M, Tomiyama H, Lee SW. The usefulness of presepsin in the early detection of anastomotic leakage after esophagectomy. Surg Open Sci 2025; 23:75-80. [PMID: 39906219 PMCID: PMC11791303 DOI: 10.1016/j.sopen.2025.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 01/08/2025] [Accepted: 01/09/2025] [Indexed: 02/06/2025] Open
Abstract
Background Anastomotic leakage is a severe complication of esophagectomy, therefore early detection is crucial. Presepsin is a biomarker for early diagnosis of infectious complications. This study assessed presepsin as a biomarker for anastomotic leakage after esophagectomy, compared to C-reactive protein (CRP), white blood cells (WBCs), and neutrophils (Neuts). Materials and methods This study enrolled 27 patients between October 2019 and December 2020. Levels of presepsin, CRP, WBCs, and Neuts were measured preoperatively and on postoperative days (PODs) 1, 3, 5, and 7. Results Five patients had anastomotic leakage. Their presepsin levels on POD 7 were significantly higher and tended to be higher on POD 5 (p = 0.04 and p = 0.06, respectively) compared to those without leakage. The area under the curve values for presepsin were highest on PODs 5 and 7 (0.89 and 0.83). Optimal cut-off values for presepsin were 400 pg/mL (sensitivity 100 %; specificity 81.9 %) on POD 5 and similar on POD 7. Conclusions Presepsin levels on PODs 5 and 7 effectively detect anastomotic leakage after esophagectomy, making it a valuable, simple, non-invasive early detection test.
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Affiliation(s)
- Yoshiro Imai
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Ryo Tanaka
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Kentaro Matsuo
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Hidero Yoshimoto
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Mitsuhiro Asakuma
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Hideki Tomiyama
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Sang-Woong Lee
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
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de Moura ELB, Pereira RW. Crossing Age Boundaries: The Unifying Potential of Presepsin in Sepsis Diagnosis Across Diverse Age Groups. J Clin Med 2024; 13:7038. [PMID: 39685497 DOI: 10.3390/jcm13237038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Revised: 10/29/2024] [Accepted: 10/31/2024] [Indexed: 12/18/2024] Open
Abstract
Sepsis is a pervasive condition that affects individuals of all ages, with significant social and economic consequences. The early diagnosis of sepsis is fundamental for establishing appropriate treatment and is based on warning scores and clinical characteristics, with positive microbiological cultures being the gold standard. Research has yet to identify a single biomarker to meet this diagnostic demand. Presepsin is a molecule that has the potential as a biomarker for diagnosing sepsis. In this paper, we present a narrative review of the diagnostic and prognostic performance of presepsin in different age groups. Given its particularities, it is identified that presepsin is a potential biomarker for sepsis at all stages of life.
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Affiliation(s)
- Edmilson Leal Bastos de Moura
- Health Sciences Doctoral Program, University of Brasília (UnB), Brasilia 70910-900, Distrito Federal, Brazil
- School of Health Sciences, Distrito Federal University (UnDF), Brasilia 70710-907, Distrito Federal, Brazil
| | - Rinaldo Wellerson Pereira
- Health Sciences Doctoral Program, University of Brasília (UnB), Brasilia 70910-900, Distrito Federal, Brazil
- Genomic Sciences and Biotechnology Graduate Program, Catholic University of Brasilia, Brasilia 71966-700, Distrito Federal, Brazil
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4
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Gamarra-Morales Y, Molina-López J, Santiago-Ruiz FC, Herrera-Quintana L, Vázquez-Lorente H, Gascón-Luna F, Planells E. Efficiency of IL-6 in Early Prognosis and Follow-Up in Critically Ill Patients with Septic Shock. Diseases 2024; 12:298. [PMID: 39589972 PMCID: PMC11592789 DOI: 10.3390/diseases12110298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Revised: 11/13/2024] [Accepted: 11/18/2024] [Indexed: 11/28/2024] Open
Abstract
Background/Objectives: The aim of this study was to investigate the response of interleukin-6 (IL-6) during the first few hours of a patient's stay in the Intensive Care Unit (ICU) in a sample of critically ill patients with septic shock, compared to healthy subjects as controls. Additionally, the study examined the association of IL-6 with morbidity and mortality in these patients, as well as its relationship with biomarkers such as lactic acid, C-reactive protein (CRP) and procalcitonin (PCT). Methods: This was a prospective analytical study involving 28 critically ill patients with septic shock, monitored from ICU admission through to their first three days of stay. Demographic data, comorbidities and clinical information, including IL-6 and severity scores, were recorded. Results: IL-6 levels were significantly higher in patients with septic shock compared to healthy subjects (p < 0.001) upon admission. IL-6 levels decreased by the third day of ICU stay (p < 0.005). An association between IL-6 and mortality was observed (areas under the curve 0.826, confidence interval (CI) 95% 0.659-0.994, p < 0.008). Significant correlations between IL-6 and lactic acid (p < 0.009 and p < 0.018) and partial thromboplastin time (p < 0.004 and p < 0.007) were found on the first and third days, respectively. IL-6 was also the correlated with an anion gap at admission to the ICU (p < 0.009). Conclusions: In conclusion, this study suggests that IL-6 could be a valuable marker for early sepsis follow-up in ICU patients, particularly during the first 72 h of hospitalization, providing important prognostic information in patients with septic shock.
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Affiliation(s)
| | - Jorge Molina-López
- Faculty of Education, Psychology and Sports Sciences, University of Huelva, 21007 Huelva, Spain
| | | | - Lourdes Herrera-Quintana
- Department of Physiology, School of Pharmacy, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, 18071 Granada, Spain; (L.H.-Q.); (H.V.-L.); (E.P.)
| | - Héctor Vázquez-Lorente
- Department of Physiology, School of Pharmacy, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, 18071 Granada, Spain; (L.H.-Q.); (H.V.-L.); (E.P.)
| | - Félix Gascón-Luna
- Clinical Analysis Unit, Valle de los Pedroches Hospital, 14400 Córdoba, Spain;
| | - Elena Planells
- Department of Physiology, School of Pharmacy, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, 18071 Granada, Spain; (L.H.-Q.); (H.V.-L.); (E.P.)
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Fogagnolo A, Spadaro S. The role of interleukin-6 in septic patients: why biomarkers cannot substitute our brain. Minerva Anestesiol 2024; 90:954-956. [PMID: 39324604 DOI: 10.23736/s0375-9393.24.18429-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Affiliation(s)
- Alberto Fogagnolo
- Section of Anesthesia and Intensive Care, Emergency Department, Sant'Anna University Hospital, University of Ferrara, Ferrara, Italy -
| | - Savino Spadaro
- Section of Anesthesia and Intensive Care, Emergency Department, Sant'Anna University Hospital, University of Ferrara, Ferrara, Italy
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
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Babel J, Košuta I, Vujaklija Brajković A, Lončar Vrančić A, Premužić V, Rogić D, Duraković N. Early Fever in Allogeneic Stem Cell Transplantation: Are Presepsin and YKL-40 Valuable Diagnostic Tools? J Clin Med 2024; 13:5991. [PMID: 39408051 PMCID: PMC11478026 DOI: 10.3390/jcm13195991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Revised: 10/02/2024] [Accepted: 10/07/2024] [Indexed: 10/20/2024] Open
Abstract
Background: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a lifesaving treatment but carries a high infection risk. Diagnosing infections remains challenging due to the limited accuracy of standard biomarkers. Methods: This single-center study aimed to evaluate presepsin (PSP) and YKL-40 as infection biomarkers in febrile patients during the allo-HSCT pre-engraftment phase. Biomarker levels were prospectively measured in 61 febrile episodes from 54 allo-HSCT patients at admission, representing baseline levels, and then at Day 1, 3, 5, and 7 following fever onset. The diagnostic value was compared to that of procalcitonin (PCT). Results: PSP showed fair diagnostic value on Day 1 (AUC 0.656; 95% CI: 0.510-0.802) and Day 3 (AUC 0.698; 95% CI: 0.559-0.837). YKL-40 did not provide any significant diagnostic value across measured time points. PCT outperformed PSP and YKL-40, particularly on Day 3 (AUC 0.712; 95% CI: 0.572-0.852). When combining biomarkers, the best model for predicting infection used PSP > 3.144 ng/mL and PCT > 0.28 μg/L on Day 3, resulting in R2 of about 31% (p < 0.001). Conclusions: Neither test showed sufficient discriminative power for early infection to recommend their use as individual diagnostic tools in clinical practice.
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Affiliation(s)
- Jakša Babel
- Division of Intensive Care Medicine, Department of Internal Medicine, University Hospital Center Zagreb, 10000 Zagreb, Croatia; (I.K.); (A.V.B.)
| | - Iva Košuta
- Division of Intensive Care Medicine, Department of Internal Medicine, University Hospital Center Zagreb, 10000 Zagreb, Croatia; (I.K.); (A.V.B.)
| | - Ana Vujaklija Brajković
- Division of Intensive Care Medicine, Department of Internal Medicine, University Hospital Center Zagreb, 10000 Zagreb, Croatia; (I.K.); (A.V.B.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
| | - Ana Lončar Vrančić
- Department of Laboratory Diagnostics, University Hospital Center Zagreb, 10000 Zagreb, Croatia; (A.L.V.); (D.R.)
| | - Vedran Premužić
- Division of Nephrology, Hypertension, Dialysis and Transplantation, Department of Internal Medicine, University Hospital Center Zagreb, 10000 Zagreb, Croatia;
| | - Dunja Rogić
- Department of Laboratory Diagnostics, University Hospital Center Zagreb, 10000 Zagreb, Croatia; (A.L.V.); (D.R.)
- Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
| | - Nadira Duraković
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
- Division of Hematology, Department of Internal Medicine, University Hospital Center Zagreb, 10000 Zagreb, Croatia
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Leng F, Gu Z, Pan S, Lin S, Wang X, Zhong M, Song J. Novel cortisol trajectory sub-phenotypes in sepsis. Crit Care 2024; 28:290. [PMID: 39227988 PMCID: PMC11370002 DOI: 10.1186/s13054-024-05071-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 08/17/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Sepsis is a heterogeneous syndrome. This study aimed to identify new sepsis sub-phenotypes using plasma cortisol trajectory. METHODS This retrospective study included patients with sepsis admitted to the intensive care unit of Zhongshan Hospital Fudan University between March 2020 and July 2022. A group-based cortisol trajectory model was used to classify septic patients into different sub-phenotypes. The clinical characteristics, biomarkers, and outcomes were compared between sub-phenotypes. RESULTS A total of 258 patients with sepsis were included, of whom 186 were male. Patients were divided into two trajectory groups: the lower-cortisol group (n = 217) exhibited consistently low and slowly declining cortisol levels, while the higher-cortisol group (n = 41) showed relatively higher levels in comparison. The 28-day mortality (65.9% vs.16.1%, P < 0.001) and 90-day mortality (65.9% vs. 19.8%, P < 0.001) of the higher-cortisol group were significantly higher than the lower-cortisol group. Multivariable Cox regression analysis showed that the trajectory sub-phenotype (HR = 5.292; 95% CI 2.218-12.626; P < 0.001), APACHE II (HR = 1.109; 95% CI 1.030-1.193; P = 0.006), SOFA (HR = 1.161; 95% CI 1.045-1.291; P = 0.006), and IL-1β (HR = 1.001; 95% CI 1.000-1.002; P = 0.007) were independent risk factors for 28-day mortality. Besides, the trajectory sub-phenotype (HR = 4.571; 95% CI 1.980-10.551; P < 0.001), APACHE II (HR = 1.108; 95% CI 1.043-1.177; P = 0.001), SOFA (HR = 1.270; 95% CI 1.130-1.428; P < 0.001), and IL-1β (HR = 1.001; 95% CI 1.000-1.001; P = 0.015) were also independent risk factors for 90-day mortality. CONCLUSION This study identified two novel cortisol trajectory sub-phenotypes in patients with sepsis. The trajectories were associated with mortality, providing new insights into sepsis classification.
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Affiliation(s)
- Fei Leng
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Zhunyong Gu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Simeng Pan
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Shilong Lin
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Xu Wang
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Ming Zhong
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Jieqiong Song
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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Igna R, Muzica C, Zenovia S, Minea H, Girleanu I, Huiban L, Trifan A. The value of presepsin and procalcitonin as prognostic factors for mortality in patients with alcoholic liver cirrhosis and acute on chronic liver failure. Arch Clin Cases 2024; 11:61-68. [PMID: 39015298 PMCID: PMC11250657 DOI: 10.22551/2024.43.1102.10290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024] Open
Abstract
Background: Acute on chronic liver failure (ACLF) is typically characterized by a rapid progression of liver failure in patients with liver cirrhosis and it is triggered by a precipitant factor, usually a bacterial infection (BI). Considering the low accuracy of the inflammation biomarkers in liver cirrhosis, presepsin and procalcitonin have demonstrated a good diagnostic performance for BI. Understanding the key prognostic factors that influence patient outcomes can significantly impact clinical decision-making and improve patient care in ACLF which can lead to lower mortality rates. Aim: To evaluate the prognostic factors associated with 30-day mortality in patients with alcohol-related liver cirrhosis and ACLF. Methods: This retrospective study on 227 patients diagnosed with ACLF and alcohol-related liver cirrhosis analyzed the prognostic role of presepsin and procalcitonin serum levels. Results: The survival analysis according to the grade of ACLF showed that more than 80% of patients with ACLF grade 1 survived after 30 days, with a mean estimated time of death of 29 ±0.44 days (95 % CI: 28.17-29.92) compared to ACLF grade 2 (24.9±1.064 days; 95 % CI: 22.82-26.99) and ACLF grade 3 (21.05±1.17 days; 95 % CI: 18.75-23.34), with a mean overall survival on entire cohort of 25.69±0.52 days (95 % CI: 24.65-26.73). Presepsin (OR: 4.008, CI 95:3.130-6.456, p=0.001) and procalcitonin (OR: 3.666, CI 95:2.312-5.813, p=0.001) were the most significant factors associated with 30-day mortality. In ACLF grade 2, presepsin provides a better prediction of mortality at the cutoff value of 1050 pg/mL (Sensitivity 72%, Specificity 69%) than procalcitonin (AUC=0.727 95% CI 0.594-0.860, p<0.002) whereas in ACLF grade 3, a cutoff of 1450 pg/mL (Sensitivity 89%, Specificity 91%) presepsin had a more significant accuracy of mortality prediction (AUC=0.93 95% CI 0.81-0.99, p<0.001) than procalcitonin (AUC=0.731 95% CI 0.655-0.807, p<0.001). Conclusion: ACLF is associated with a high mortality rate and the risk of death increases with the grade of ACLF. Presepsin and procalcitonin serum levels are good prognostic factors for 30-day mortality and should be used in clinical practice to stratify the risk and provide and early and efficient treatment in patients with ACLF.
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Affiliation(s)
- Răzvan Igna
- Intensive Care Unit, “Sf. Spiridon” University Hospital, Iasi, Romania
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Cristina Muzica
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Institute of Gastroenterology and Hepatology, “Sf. Spiridon” University Hospital, Iasi, Romania
| | - Sebastian Zenovia
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Institute of Gastroenterology and Hepatology, “Sf. Spiridon” University Hospital, Iasi, Romania
| | - Horia Minea
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Institute of Gastroenterology and Hepatology, “Sf. Spiridon” University Hospital, Iasi, Romania
| | - Irina Girleanu
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Institute of Gastroenterology and Hepatology, “Sf. Spiridon” University Hospital, Iasi, Romania
| | - Laura Huiban
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Institute of Gastroenterology and Hepatology, “Sf. Spiridon” University Hospital, Iasi, Romania
| | - Anca Trifan
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Institute of Gastroenterology and Hepatology, “Sf. Spiridon” University Hospital, Iasi, Romania
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Jang JH, Choi E, Kim T, Yeo HJ, Jeon D, Kim YS, Cho WH. Navigating the Modern Landscape of Sepsis: Advances in Diagnosis and Treatment. Int J Mol Sci 2024; 25:7396. [PMID: 39000503 PMCID: PMC11242529 DOI: 10.3390/ijms25137396] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/27/2024] [Accepted: 07/03/2024] [Indexed: 07/16/2024] Open
Abstract
Sepsis poses a significant threat to human health due to its high morbidity and mortality rates worldwide. Traditional diagnostic methods for identifying sepsis or its causative organisms are time-consuming and contribute to a high mortality rate. Biomarkers have been developed to overcome these limitations and are currently used for sepsis diagnosis, prognosis prediction, and treatment response assessment. Over the past few decades, more than 250 biomarkers have been identified, a few of which have been used in clinical decision-making. Consistent with the limitations of diagnosing sepsis, there is currently no specific treatment for sepsis. Currently, the general treatment for sepsis is conservative and includes timely antibiotic use and hemodynamic support. When planning sepsis-specific treatment, it is important to select the most suitable patient, considering the heterogeneous nature of sepsis. This comprehensive review summarizes current and evolving biomarkers and therapeutic approaches for sepsis.
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Affiliation(s)
- Jin Ho Jang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Transplantation Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea; (J.H.J.); (E.C.); (T.K.); (H.J.Y.); (D.J.); (Y.S.K.)
- Department of Internal Medicine, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea
| | - Eunjeong Choi
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Transplantation Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea; (J.H.J.); (E.C.); (T.K.); (H.J.Y.); (D.J.); (Y.S.K.)
- Department of Internal Medicine, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea
| | - Taehwa Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Transplantation Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea; (J.H.J.); (E.C.); (T.K.); (H.J.Y.); (D.J.); (Y.S.K.)
- Department of Internal Medicine, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea
| | - Hye Ju Yeo
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Transplantation Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea; (J.H.J.); (E.C.); (T.K.); (H.J.Y.); (D.J.); (Y.S.K.)
- Department of Internal Medicine, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea
| | - Doosoo Jeon
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Transplantation Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea; (J.H.J.); (E.C.); (T.K.); (H.J.Y.); (D.J.); (Y.S.K.)
- Department of Internal Medicine, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea
| | - Yun Seong Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Transplantation Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea; (J.H.J.); (E.C.); (T.K.); (H.J.Y.); (D.J.); (Y.S.K.)
- Department of Internal Medicine, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea
| | - Woo Hyun Cho
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Transplantation Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea; (J.H.J.); (E.C.); (T.K.); (H.J.Y.); (D.J.); (Y.S.K.)
- Department of Internal Medicine, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea
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10
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Akdeniz YS, Özkan S. New markers in chronic obstructive pulmonary disease. Adv Clin Chem 2024; 123:1-63. [PMID: 39181619 DOI: 10.1016/bs.acc.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Chronic obstructive pulmonary disease (COPD), a global healthcare and socioeconomic burden, is a multifaceted respiratory disorder that results in substantial decline in health status and life quality. Acute exacerbations of the disease contribute significantly to increased morbidity and mortality. Consequently, the identification of reliable and effective biomarkers for rapid diagnosis, prediction, and prognosis of exacerbations is imperative. In addition, biomarkers play a crucial role in monitoring responses to therapeutic interventions and exploring innovative treatment strategies. Although established markers such as CRP, fibrinogen and neutrophil count are routinely used, a universal marker is lacking. Fortunately, an increasing number of studies based on next generation analytics have explored potential biomarkers in COPD. Here we review those advances and the need for standardized validation studies in the appropriate clinical setting.
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Affiliation(s)
- Yonca Senem Akdeniz
- Department of Emergency Medicine, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Türkiye.
| | - Seda Özkan
- Department of Emergency Medicine, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Türkiye
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Formenti P, Gotti M, Palmieri F, Pastori S, Roccaforte V, Menozzi A, Galimberti A, Umbrello M, Sabbatini G, Pezzi A. Presepsin in Critical Illness: Current Knowledge and Future Perspectives. Diagnostics (Basel) 2024; 14:1311. [PMID: 38928726 PMCID: PMC11202475 DOI: 10.3390/diagnostics14121311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
The accurate identification of infections is critical for effective treatment in intensive care units (ICUs), yet current diagnostic methods face limitations in sensitivity and specificity, alongside cost and accessibility issues. Consequently, there is a pressing need for a marker that is economically feasible, rapid, and reliable. Presepsin (PSP), also known as soluble CD14 subtype (sCD14-ST), has emerged as a promising biomarker for early sepsis diagnosis. PSP, derived from soluble CD14, reflects the activation of monocytes/macrophages in response to bacterial infections. It has shown potential as a marker of cellular immune response activation against pathogens, with plasma concentrations increasing during bacterial infections and decreasing post-antibiotic treatment. Unlike traditional markers such as procalcitonin (PCT) and C-reactive protein (CRP), PSP specifically indicates monocyte/macrophage activation. Limited studies in critical illness have explored PSP's role in sepsis, and its diagnostic accuracy varies with threshold values, impacting sensitivity and specificity. Recent meta-analyses suggest PSP's diagnostic potential for sepsis, yet its standalone effectiveness in ICU infection management remains uncertain. This review provides a comprehensive overview of PSP's utility in ICU settings, including its diagnostic accuracy, prognostic value, therapeutic implications, challenges, and future directions.
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Affiliation(s)
- Paolo Formenti
- Department of Anesthesia and Intensive Care, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (M.G.); (F.P.); (A.G.); (G.S.); (A.P.)
| | - Miriam Gotti
- Department of Anesthesia and Intensive Care, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (M.G.); (F.P.); (A.G.); (G.S.); (A.P.)
| | - Francesca Palmieri
- Department of Anesthesia and Intensive Care, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (M.G.); (F.P.); (A.G.); (G.S.); (A.P.)
| | - Stefano Pastori
- Department of Clinical Chemistry and Microbiological Analysis, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (S.P.); (V.R.)
| | - Vincenzo Roccaforte
- Department of Clinical Chemistry and Microbiological Analysis, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (S.P.); (V.R.)
| | - Alessandro Menozzi
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy;
| | - Andrea Galimberti
- Department of Anesthesia and Intensive Care, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (M.G.); (F.P.); (A.G.); (G.S.); (A.P.)
| | - Michele Umbrello
- Department of Intensive Care, ASST Ovest Milanese, New Hospital of Legnano, 20025 Legnano, Italy;
| | - Giovanni Sabbatini
- Department of Anesthesia and Intensive Care, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (M.G.); (F.P.); (A.G.); (G.S.); (A.P.)
| | - Angelo Pezzi
- Department of Anesthesia and Intensive Care, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (M.G.); (F.P.); (A.G.); (G.S.); (A.P.)
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Julián-Jiménez A, García de Guadiana-Romualdo L, Merinos-Sánchez G, García DE. Diagnostic accuracy of procalcitonin for bacterial infection in the Emergency Department: a systematic review. Rev Clin Esp 2024; 224:400-416. [PMID: 38815753 DOI: 10.1016/j.rceng.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/22/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION AND OBJECTIVE The care of patients with a suspected infectious process in hospital emergency departments (ED) accounts for 15%-35% of all daily care in these healthcare areas in Spain and Latin America. The early and adequate administration of antibiotic treatment (AB) and the immediate making of other diagnostic-therapeutic decisions have a direct impact on the survival of patients with severe bacterial infection. The main objective of this systematic review is to investigate the diagnostic accuracy of PCT to predict bacterial infection in adult patients treated with clinical suspicion of infection in the ED, as well as to analyze whether the different studies manage to identify a specific value of PCT as the most relevant from the diagnostic point of view of clinical decision that can be recommended for decision making in ED. METHOD A systematic review is carried out following the PRISMA regulations in the database of PubMed, Web of Science, EMBASE, Lilacs, Cochrane, Epistemonikos, Tripdatabase and ClinicalTrials.gov from January 2005 to May 31, 2023 without language restriction and using a combination of MESH terms: "Procalcitonin", "Infection/Bacterial Infection/Sepsis", "Emergencies/Emergency/Emergency Department", "Adults" and "Diagnostic". Observational cohort studies (diagnostic performance analyses) were included. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the method used and the risk of bias of the included articles. Observational cohort studies were included. No meta-analysis techniques were performed, but results were compared narratively. RESULTS A total of 1,323 articles were identified, of which 21 that met the inclusion criteria were finally analyzed. The studies include 10,333 patients with 4,856 bacterial infections (47%). Eight studies were rated as high, 9 as moderate, and 4 as low. The AUC-ROC of all studies ranges from 0.68 (95% CI: 0.61-0.72) to 0.99 (95% CI: 0.98-1). The value of PCT 0.2-0.3 ng/ml is the most used and proposed in up to twelve of the works included in this review whose average estimated performance is an AUC-ROC of 0.79. If only the results of the 5 high-quality studies using a cut-off point of 0.2-0.3 ng/ml PCT are taken into account, the estimated mean AUC-COR result is 0.78 with Se:69 % and Es:76%. CONCLUSIONS PCT has considerable diagnostic accuracy for bacterial infection in patients treated in ED for different infectious processes. The cut-off point of 0.25 (0.2-0.3) ng/ml has been positioned as the most appropriate to predict the existence of bacterial infection and can be used to help reasonably rule it out.
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Affiliation(s)
- A Julián-Jiménez
- Servicio de Urgencias, Complejo Hospitalario Universitario de Toledo, IDISCAM, Universidad de Castilla La Mancha, Toledo, Spain.
| | | | - G Merinos-Sánchez
- Servicio de Urgencias, Hospital General de México «Dr. Eduardo Liceaga», Ciudad de México, Mexico
| | - D E García
- Hospital de Alta Complejidad El Cruce, Florencio Varela, Buenos Aires, Argentina
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Wu Z, Geng N, Liu Z, Pan W, Zhu Y, Shan J, Shi H, Han Y, Ma Y, Liu B. Presepsin as a prognostic biomarker in COVID-19 patients: combining clinical scoring systems and laboratory inflammatory markers for outcome prediction. Virol J 2024; 21:96. [PMID: 38671532 PMCID: PMC11046891 DOI: 10.1186/s12985-024-02367-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND There is still limited research on the prognostic value of Presepsin as a biomarker for predicting the outcome of COVID-19 patients. Additionally, research on the combined predictive value of Presepsin with clinical scoring systems and inflammation markers for disease prognosis is lacking. METHODS A total of 226 COVID-19 patients admitted to Beijing Youan Hospital's emergency department from May to November 2022 were screened. Demographic information, laboratory measurements, and blood samples for Presepsin levels were collected upon admission. The predictive value of Presepsin, clinical scoring systems, and inflammation markers for 28-day mortality was analyzed. RESULTS A total of 190 patients were analyzed, 83 (43.7%) were mild, 61 (32.1%) were moderate, and 46 (24.2%) were severe/critically ill. 23 (12.1%) patients died within 28 days. The Presepsin levels in severe/critical patients were significantly higher compared to moderate and mild patients (p < 0.001). Presepsin showed significant predictive value for 28-day mortality in COVID-19 patients, with an area under the ROC curve of 0.828 (95% CI: 0.737-0.920). Clinical scoring systems and inflammation markers also played a significant role in predicting 28-day outcomes. After Cox regression adjustment, Presepsin, qSOFA, NEWS2, PSI, CURB-65, CRP, NLR, CAR, and LCR were identified as independent predictors of 28-day mortality in COVID-19 patients (all p-values < 0.05). Combining Presepsin with clinical scoring systems and inflammation markers further enhanced the predictive value for patient prognosis. CONCLUSION Presepsin is a favorable indicator for the prognosis of COVID-19 patients, and its combination with clinical scoring systems and inflammation markers improved prognostic assessment.
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Affiliation(s)
- Zhipeng Wu
- Department of Respiratory and Critical Care Medicine, Beijing Youan Hospital, Capital Medical University, No. 8, Xi Tou Tiao, Youanmenwai Street, Fengtai District, Beijing City, 100069, People's Republic of China
- Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People's Republic of China
- Beijing Research Center for Respiratory Infectious Diseases, Beijing, People's Republic of China
| | - Nan Geng
- Department of Emergency Medicine, Beijing Youan Hospital, Capital Medical University, Beijing City, 100069, People's Republic of China
| | - Zhao Liu
- Department of Emergency Medicine, Beijing Youan Hospital, Capital Medical University, Beijing City, 100069, People's Republic of China
| | - Wen Pan
- Department of Emergency Medicine, Beijing Youan Hospital, Capital Medical University, Beijing City, 100069, People's Republic of China
| | - Yueke Zhu
- Department of Emergency Medicine, Beijing Youan Hospital, Capital Medical University, Beijing City, 100069, People's Republic of China
| | - Jing Shan
- Department of Emergency Medicine, Beijing Youan Hospital, Capital Medical University, Beijing City, 100069, People's Republic of China
| | - Hongbo Shi
- Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People's Republic of China
| | - Ying Han
- Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People's Republic of China
| | - Yingmin Ma
- Department of Respiratory and Critical Care Medicine, Beijing Youan Hospital, Capital Medical University, No. 8, Xi Tou Tiao, Youanmenwai Street, Fengtai District, Beijing City, 100069, People's Republic of China.
- Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People's Republic of China.
- Beijing Research Center for Respiratory Infectious Diseases, Beijing, People's Republic of China.
| | - Bo Liu
- Department of Emergency Medicine, Beijing Youan Hospital, Capital Medical University, Beijing City, 100069, People's Republic of China.
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Ha EY, Park IR, Chung SM, Roh YN, Park CH, Kim TG, Kim W, Moon JS. The Potential Role of Presepsin in Predicting Severe Infection in Patients with Diabetic Foot Ulcers. J Clin Med 2024; 13:2311. [PMID: 38673584 PMCID: PMC11051563 DOI: 10.3390/jcm13082311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/10/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
Background/Objectives: Diabetic foot ulcers are one of the complications in patients with diabetes, which can be caused by infection, neuropathy, and blood vessel disorder. Among them, infection is the most common cause, and if it becomes worse, amputation may be necessary. So, it is important to detect and treat infections early, and determining indicators that can confirm infection is also important. Known infection markers include white blood cells (WBCs), the erythrocyte sediment rate (ESR), C-reactive protein (CRP), and procalcitonin, but they are not specific to diabetic foot ulcers. Presepsin, also known as soluble CD14, is known to be an early indicator of sepsis. Recent studies have reported that presepsin can be used as an early indicator of infection. This study investigated whether presepsin could be used as an early marker of severe infection in patients with diabetic foot ulcers. Methods: We retrospectively studied 73 patients who were treated for diabetic foot ulcerations from January 2021 to June 2023 at Yeungnam University Hospital. Results: Out of a total of 73 patients, 46 patients underwent amputations with severe infections, and the WBC level, ESR, and CRP, procalcitonin, and presepsin levels were significantly higher in the group of patients who underwent amputations. The cutoff of presepsin, which can predict serious infections that need amputation, was 675 ng/mL. A regression analysis confirmed that presepsin, HbA1c, and osteomyelitis significantly increased the risk of severe infections requiring amputation. Conclusions: Presepsin will be available as an early predictor of patients with severe infections requiring amputations for diabetic foot ulcerations.
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Affiliation(s)
- Eun Yeong Ha
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu 42415, Republic of Korea; (E.Y.H.); (I.R.P.); (S.M.C.); (W.K.)
| | - Il Rae Park
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu 42415, Republic of Korea; (E.Y.H.); (I.R.P.); (S.M.C.); (W.K.)
| | - Seung Min Chung
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu 42415, Republic of Korea; (E.Y.H.); (I.R.P.); (S.M.C.); (W.K.)
| | - Young Nam Roh
- Department of Surgery, Yeungnam University Medical Center, Daegu 42415, Republic of Korea;
| | - Chul Hyun Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu 42415, Republic of Korea;
| | - Tae-Gon Kim
- Department of Plastic Surgery, Yeungnam University Medical Center, Daegu 42415, Republic of Korea;
| | - Woong Kim
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu 42415, Republic of Korea; (E.Y.H.); (I.R.P.); (S.M.C.); (W.K.)
| | - Jun Sung Moon
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu 42415, Republic of Korea; (E.Y.H.); (I.R.P.); (S.M.C.); (W.K.)
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15
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Wei S, Shen Z, Yin Y, Cong Z, Zeng Z, Zhu X. Advances of presepsin in sepsis-associated ARDS. Postgrad Med J 2024; 100:209-218. [PMID: 38147883 DOI: 10.1093/postmj/qgad132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/30/2023] [Accepted: 12/02/2023] [Indexed: 12/28/2023]
Abstract
This article reviews the correlation between presepsin and sepsis and the resulting acute respiratory distress syndrome (ARDS). ARDS is a severe complication of sepsis. Despite the successful application of protective mechanical ventilation, restrictive fluid therapy, and neuromuscular blockade, which have effectively reduced the morbidity and mortality associated with ARDS, the mortality rate among patients with sepsis-associated ARDS remains notably high. The challenge lies in the prediction of ARDS onset and the timely implementation of intervention strategies. Recent studies have demonstrated significant variations in presepsin (PSEP) levels between patients with sepsis and those without, particularly in the context of ARDS. Moreover, these studies have revealed substantially elevated PSEP levels in patients with sepsis-associated ARDS compared to those with nonsepsis-associated ARDS. Consequently, PSEP emerges as a valuable biomarker for identifying patients with an increased risk of sepsis-associated ARDS and to predict in-hospital mortality.
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Affiliation(s)
- Senhao Wei
- Department of Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
- Graduate School of Peking University Health Science Center, Peking University Health Science Center, Beijing 100191, China
| | - Ziyuan Shen
- Department of Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
- Graduate School of Peking University Health Science Center, Peking University Health Science Center, Beijing 100191, China
| | - Yiyuan Yin
- Department of Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Zhukai Cong
- Department of Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Zhaojin Zeng
- Department of Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
- Graduate School of Peking University Health Science Center, Peking University Health Science Center, Beijing 100191, China
| | - Xi Zhu
- Department of Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
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Kim SW, Kim JY, Yoon YH, Park SJ, Shim BS. Usefulness of presepsin as a prognostic indicator for patients with trauma in the emergency department in Korea: a retrospective study. JOURNAL OF TRAUMA AND INJURY 2024; 37:13-19. [PMID: 39381153 PMCID: PMC11309192 DOI: 10.20408/jti.2023.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/24/2023] [Accepted: 10/31/2023] [Indexed: 10/10/2024] Open
Abstract
Purpose Trauma is an important public health concern, and it is important to increase the survival rate of patients with trauma and enable them to return to society in a better condition. Initial treatment in the emergency department (ED) is closely associated with the prognosis of patients with trauma. However, studies regarding laboratory biomarker tests that can help predict the prognosis of trauma patients are limited. Presepsin is a novel biomarker of inflammation that can predict a poor prognosis in patients with sepsis. This study aimed to determine whether presepsin could be used as a prognostic indicator in patients with polytrauma. Methods The study included patients with trauma who had visited a single regional ED from November 2021 to January 2023. Patients who had laboratory tests in the ED were included and analyzed retrospectively through chart review. Age, sex, injury mechanism, vital signs, surgery, the outcome of ED treatment (admission, discharge, transfer, or death), and trauma scores were analyzed. Results Overall, 550 trauma patients were enrolled; 59.1% were men, and the median age was 64 years (interquartile range, 48.8-79.0 years). Patients in a hypotensive state (systolic blood pressure, <90 mmHg; n=39) had higher presepsin levels (1,061.5±2,522.7 pg/mL) than those in a nonhypotensive state (n=511, 545.7±688.4 pg/mL, P<0.001). Patients hospitalized after ED treatment had the highest presepsin levels (660.9 pg/mL), followed by those who died (652.0 pg/mL), were transferred to other hospitals (514.9 pg/mL), and returned home (448.0 pg/mL, P=0.041). Conclusions Serum presepsin levels were significantly higher in trauma patients in a hypotensive state than in those in a nonhypotensive state. Additionally, serum presepsin levels were the highest in hospitalized patients with trauma, followed by those who died, were transferred to other hospitals, and returned home.
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Affiliation(s)
- Si Woo Kim
- Department of Emergency Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jung-Youn Kim
- Department of Emergency Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young-Hoon Yoon
- Department of Emergency Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Joon Park
- Department of Emergency Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Bo Sun Shim
- Department of Emergency Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Xiao H, Zhang H, Wang G, Wang Y, Tan Z, Sun X, Zhou J, Duan M, Zhi D, Hang C, Zhang G, Li Y, Wu C, Zhang H, Xie M, Li C. COMPARISON AMONG PRESEPSIN, PROCALCITONIN, AND C-REACTIVE PROTEIN IN PREDICTING BLOOD CULTURE POSITIVITY AND PATHOGEN IN SEPSIS PATIENTS. Shock 2024; 61:387-394. [PMID: 37878488 DOI: 10.1097/shk.0000000000002243] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
ABSTRACT Background: Sepsis is caused by the invasion of the bloodstream by microorganisms from local sites of infection, leading to high mortality. This study aimed to compare the predictive ability of the biomarkers presepsin, procalcitonin (PCT), and C-reactive protein for bacteraemia. Methods: In this retrospective, multicentre study, a dataset of patients with sepsis who were prospectively enrolled between November 2017 and June 2021 was analyzed. The performances of the biomarkers for predicting positive blood cultures and infection with specific pathogens were assessed by the areas under the receiver operating characteristic curves (AUCs). The independent effects of the pathogen and foci of infection on presepsin and PCT levels were assessed by linear logistic regression models. Results: A total of 577 patients with 170 positive blood cultures (29.5%) were enrolled. The AUC achieved using PCT levels (0.856) was significantly higher than that achieved using presepsin (0.786, P = 0.0200) and C-reactive protein (0.550, P < 0.0001) levels in predicting bacteraemia. The combined analysis of PCT and presepsin levels led to a significantly higher AUC than the analysis of PCT levels alone for predicting blood culture positivity (0.877 vs. 0.856, P = 0.0344) and gram-negative bacteraemia (0.900 vs. 0.875, P = 0.0216). In a linear regression model, the elevated concentrations of presepsin and PCT were both independently related to Escherichia coli , Klebsiella species, Pseudomonas species, and Streptococcus species infections and Sequential Organ Failure Assessment score. Presepsin levels were also associated with Acinetobacter species and abdominal infection, and PCT levels were positively associated with other Enterobacteriaceae and negatively associated with respiratory infection. Combined analysis of presepsin and PCT levels provided a high sensitivity and specificity in identifying E. coli or Klebsiella species infection. Conclusions: Presepsin and PCT were promising markers for predicting bacteraemia and common pathogens at the time of sepsis onset with a synergistic effect.
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Affiliation(s)
- Hongli Xiao
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hanyu Zhang
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Guoxing Wang
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yan Wang
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhimin Tan
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xuelian Sun
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jie Zhou
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Deyuan Zhi
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chenchen Hang
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Guoqiang Zhang
- Department of Emergency Medicine, China-Japan Friendship Hospital, Peking Union Medical College, Beijing, China
| | - Yan Li
- Department of Emergency Medicine, China-Japan Friendship Hospital, Peking Union Medical College, Beijing, China
| | - Caijun Wu
- Department of Emergency Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Haiyan Zhang
- Department of Emergency Medicine, The Hospital of Shunyi District Beijing, China Medical University, Beijing, China
| | - Miaorong Xie
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chunsheng Li
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Shimoyama Y, Kadono N, Umegaki O. Presepsin is a more useful predictor of septic AKI and ARDS for very-old sepsis patients than for young sepsis patients in ICUs: a pilot study. BMC Res Notes 2024; 17:53. [PMID: 38378647 PMCID: PMC10877906 DOI: 10.1186/s13104-024-06719-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 02/14/2024] [Indexed: 02/22/2024] Open
Abstract
OBJECTIVE Sepsis is a syndrome of life-threatening organ dysfunction. This study aimed to determine whether presepsin is a useful predictor of septic acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), and shock in very-old sepsis patients aged 75 years in intensive care units (ICUs). RESULTS A total of 83 adult patients diagnosed with sepsis were prospectively examined and divided into two groups: those aged 75 years and older (over 75 group) and those aged younger than 75 years (under 75 group). Presepsin values were measured after ICU admission. Inflammation-based prognostic scores were also examined. For category classification, total scores ("inflammation-presepsin scores [iPS]") were calculated. Presepsin values, inflammation-based prognostic scores, and iPS were compared between patients with septic AKI, ARDS, DIC, or shock and those without these disorders in the over 75 and under 75 groups. Areas under the curve of presepsin for predicting septic AKI and ARDS in the over 75 group were both > 0.7, which were significantly higher than those in the under 75 group. In conclusion, presepsin is a more useful predictor of septic AKI and ARDS for very-old sepsis patients (over 75 years) than for younger sepsis patients (under 75 years).
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Affiliation(s)
- Yuichiro Shimoyama
- Department of Anesthesiology, Intensive Care Unit, Osaka Medical and Pharmaceutical University, Osaka Medical and Pharmaceutical University Hospital, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Noriko Kadono
- Department of Anesthesiology, Intensive Care Unit, Osaka Medical and Pharmaceutical University, Osaka Medical and Pharmaceutical University Hospital, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Osamu Umegaki
- Department of Anesthesiology, Intensive Care Unit, Osaka Medical and Pharmaceutical University, Osaka Medical and Pharmaceutical University Hospital, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
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Cicchinelli S, Pignataro G, Gemma S, Piccioni A, Picozzi D, Ojetti V, Franceschi F, Candelli M. PAMPs and DAMPs in Sepsis: A Review of Their Molecular Features and Potential Clinical Implications. Int J Mol Sci 2024; 25:962. [PMID: 38256033 PMCID: PMC10815927 DOI: 10.3390/ijms25020962] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/31/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Sepsis is a serious organ dysfunction caused by a dysregulated immune host reaction to a pathogen. The innate immunity is programmed to react immediately to conserved molecules, released by the pathogens (PAMPs), and the host (DAMPs). We aimed to review the molecular mechanisms of the early phases of sepsis, focusing on PAMPs, DAMPs, and their related pathways, to identify potential biomarkers. We included studies published in English and searched on PubMed® and Cochrane®. After a detailed discussion on the actual knowledge of PAMPs/DAMPs, we analyzed their role in the different organs affected by sepsis, trying to elucidate the molecular basis of some of the most-used prognostic scores for sepsis. Furthermore, we described a chronological trend for the release of PAMPs/DAMPs that may be useful to identify different subsets of septic patients, who may benefit from targeted therapies. These findings are preliminary since these pathways seem to be strongly influenced by the peculiar characteristics of different pathogens and host features. Due to these reasons, while initial findings are promising, additional studies are necessary to clarify the potential involvement of these molecular patterns in the natural evolution of sepsis and to facilitate their transition into the clinical setting.
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Affiliation(s)
- Sara Cicchinelli
- Department of Emergency, S.S. Filippo e Nicola Hospital, 67051 Avezzano, Italy;
| | - Giulia Pignataro
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli—IRRCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (G.P.); (S.G.); (A.P.); (D.P.); (V.O.); (F.F.)
| | - Stefania Gemma
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli—IRRCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (G.P.); (S.G.); (A.P.); (D.P.); (V.O.); (F.F.)
| | - Andrea Piccioni
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli—IRRCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (G.P.); (S.G.); (A.P.); (D.P.); (V.O.); (F.F.)
| | - Domitilla Picozzi
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli—IRRCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (G.P.); (S.G.); (A.P.); (D.P.); (V.O.); (F.F.)
| | - Veronica Ojetti
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli—IRRCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (G.P.); (S.G.); (A.P.); (D.P.); (V.O.); (F.F.)
| | - Francesco Franceschi
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli—IRRCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (G.P.); (S.G.); (A.P.); (D.P.); (V.O.); (F.F.)
| | - Marcello Candelli
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli—IRRCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (G.P.); (S.G.); (A.P.); (D.P.); (V.O.); (F.F.)
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20
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Ren E, Xiao H, Wang G, Zhao Y, Yu H, Li C. Value of procalcitonin and presepsin in the diagnosis and severity stratification of sepsis and septic shock. World J Emerg Med 2024; 15:135-138. [PMID: 38476536 PMCID: PMC10925532 DOI: 10.5847/wjem.j.1920-8642.2024.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/26/2023] [Indexed: 03/14/2024] Open
Affiliation(s)
- Enfeng Ren
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Hongli Xiao
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Guoxing Wang
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Yongzhen Zhao
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100050, China
| | - Han Yu
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100050, China
| | - Chunsheng Li
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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21
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Lu CY, Kao CL, Hung KC, Wu JY, Hsu HC, Yu CH, Chang WT, Feng PH, Chen IW. Diagnostic efficacy of serum presepsin for postoperative infectious complications: a meta-analysis. Front Immunol 2023; 14:1320683. [PMID: 38149257 PMCID: PMC10750271 DOI: 10.3389/fimmu.2023.1320683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/28/2023] [Indexed: 12/28/2023] Open
Abstract
Background Postoperative infectious complications (PICs) are major concerns. Early and accurate diagnosis is critical for timely treatment and improved outcomes. Presepsin is an emerging biomarker for bacterial infections. However, its diagnostic efficacy for PICs across surgical specialties remains unclear. Methods In this study, a systematic search on MEDLINE, Embase, Google Scholar, and Cochrane Library was performed on September 30, 2023, to identify studies that evaluated presepsin for diagnosing PICs. PIC is defined as the development of surgical site infection or remote infection. Pooled sensitivity, specificity, and hierarchical summary receiver operating characteristic (HSROC) curves were calculated. The primary outcome was the assessment of the efficacy of presepsin for PIC diagnosis, and the secondary outcome was the investigation of the reliability of procalcitonin or C-reactive protein (CRP) in the diagnosis of PICs. Results This meta-analysis included eight studies (n = 984) and revealed that the pooled sensitivity and specificity of presepsin for PIC diagnosis were 76% (95% confidence interval [CI] 68%-82%) and 83% (95% CI 75%-89%), respectively. The HSROC curve yielded an area under the curve (AUC) of 0.77 (95% CI 0.73-0.81). Analysis of six studies on procalcitonin showed a combined sensitivity of 78% and specificity of 77%, with an AUC of 0.83 derived from the HSROC. Meanwhile, data from five studies on CRP indicated pooled sensitivity of 84% and specificity of 79%, with the HSROC curve yielding an AUC of 0.89. Conclusion Presepsin exhibits moderate diagnostic accuracy for PIC across surgical disciplines. Based on the HSROC-derived AUC, CRP has the highest diagnostic efficacy for PICs, followed by procalcitonin and presepsin. Nonetheless, presepsin demonstrated greater specificity than the other biomarkers. Further study is warranted to validate the utility of and optimize the cutoff values for presepsin. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42023468358.
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Affiliation(s)
- Chun-Ying Lu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chia-Li Kao
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Jheng-Yan Wu
- Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan
| | - Hui-Chen Hsu
- Department of Otolaryngology, Kuang Tien General Hospital, Taichung, Taiwan
| | - Chia-Hung Yu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Wei-Ting Chang
- School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Ping-Hsun Feng
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan
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22
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de Nooijer AH, Pickkers P, Netea MG, Kox M. Inflammatory biomarkers to predict the prognosis of acute bacterial and viral infections. J Crit Care 2023; 78:154360. [PMID: 37343422 DOI: 10.1016/j.jcrc.2023.154360] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/07/2023] [Indexed: 06/23/2023]
Abstract
Mortality in acute infections is mostly associated with sepsis, defined as 'life-threatening organ dysfunction caused by a dysregulated host response to infection'. It remains challenging to identify the patients with increased mortality risk due to the high heterogeneity in the dysregulated host immune response and disease progression. Biomarkers reflecting different pathways involved in the inflammatory response might improve prediction of mortality risk (prognostic enrichment) among patients with acute infections by reducing heterogeneity of the host response, as well as suggest novel strategies for patient stratification and treatment (predictive enrichment) through precision medicine approaches. The predictive value of inflammatory biomarkers has been extensively investigated in bacterial infections and the recent COVID-19 pandemic caused an increased interest in inflammatory biomarkers in this viral infection. However, limited research investigated whether the prognostic potential of these biomarkers differs between bacterial and viral infections. In this narrative review, we provide an overview of the value of various inflammatory biomarkers for the prediction of mortality in bacterial and viral infections.
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Affiliation(s)
- Aline H de Nooijer
- Department of Internal Medicine, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands; Department of Intensive Care Medicine, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands; Radboud University Medical Center for Infectious Diseases, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands; Radboud University Medical Center for Infectious Diseases, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands
| | - Mihai G Netea
- Department of Internal Medicine, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands; Radboud University Medical Center for Infectious Diseases, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands; Department of Immunology and Metabolism, Life & Medical Sciences Institute, University of Bonn, 53115 Bonn, Germany
| | - Matthijs Kox
- Department of Intensive Care Medicine, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands; Radboud University Medical Center for Infectious Diseases, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands.
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Paraskevas T, Chourpiliadi C, Demiri S, Micahilides C, Karanikolas E, Lagadinou M, Velissaris D. Presepsin in the diagnosis of sepsis. Clin Chim Acta 2023; 550:117588. [PMID: 37813329 DOI: 10.1016/j.cca.2023.117588] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES Sepsis is a life-threatening condition characterized by organ dysfunction. It occurs due to the host's dysregulated response to an infection. Clinicians use inflammatory biomarkers to evaluate patients at risk of sepsis in various settings. METHODS We included studies focusing on the diagnostic accuracy of presepsin in patients under suspicion of sepsis. The bivariate model of Reitsma was used for the quantitative synthesis, and summary estimates were calculated. The Zhou-Dendukuri approach was followed to assess heterogeneity. Subgroup analyses were performed based on settings and diagnostic criteria. RESULTS The summary sensitivity for diagnosing sepsis was 0.805 (95 % CI: 0.759-0.844), while the false positive rate (FPR) was 0.174 (95 % CI: 0.124-0.239). The area under the curve (AUC) for the summary receiver operating characteristic (SROC) curve was 0.875, with a slightly lower partial AUC of 0.833. The analysis using the Zhou-Dendukuri approach revealed low heterogeneity (I2 = 15.9 %). Subgroup analyses showed no significant differences in SROC curves and summary estimates between the ED and ICU settings, although the ED subgroup exhibited higher heterogeneity (I2 = 52.7 % vs. 20.2 %). The comparison between the diagnostic criteria, Sepsis 1 and Sepsis 3, demonstrated similar summary estimates and SROC curves. The examination of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool revealed a high risk of bias regarding the participants and their applicability. Also, there was an increased risk of bias in all the studies concerning the index test. CONCLUSION Based on our research, presepsin is a promising biomarker for triage and early diagnosis of sepsis.
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Affiliation(s)
| | | | - Silvia Demiri
- Department of Internal Medicine, University Hospital of Patras, Patras, Greece.
| | | | - Evangelos Karanikolas
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, USA.
| | - Maria Lagadinou
- Department of Internal Medicine, University Hospital of Patras, Patras, Greece.
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Ahuja N, Mishra A, Gupta R, Ray S. Biomarkers in sepsis-looking for the Holy Grail or chasing a mirage! World J Crit Care Med 2023; 12:188-203. [PMID: 37745257 PMCID: PMC10515097 DOI: 10.5492/wjccm.v12.i4.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/12/2023] [Accepted: 06/12/2023] [Indexed: 09/05/2023] Open
Abstract
Sepsis is defined as a life-threatening organ dysfunction caused by the dysregulated host response to infection. It is a complex syndrome and is characterized by physiologic, pathologic and biochemical abnormalities in response to an infection. Diagnosis of sepsis is based on history, physical examination and other investigations (including biomarkers) which may help to increase the certainty of diagnosis. Biomarkers have been evaluated in the past for many diseases and have been evaluated for sepsis as well. Biomarkers may find a possible role in diagnosis, prognostication, therapeutic monitoring and anti-microbial stewardship in sepsis. Since the pathophysiology of sepsis is quite complex and is incompletely understood, a single biomarker that may be robust enough to provide all information has not been found as of yet. However, many biomarkers have been studied and some of them have applications at the bedside and guide clinical decision-making. We evaluated the PubMed database to search for sepsis biomarkers for diagnosis, prognosis and possible role in antibiotic escalation and de-escalation. Clinical trials, meta-analyses, systematic reviews and randomized controlled trials were included. Commonly studied biomarkers such as procalcitonin, Soluble urokinase-type plasminogen activator (Supar), presepsin, soluble triggering receptor expressed on myeloid cells 1, interleukin 6, C-reactive protein, etc., have been described for their possible applications as biomarkers in septic patients. The sepsis biomarkers are still an area of active research with newer evidence adding to the knowledge base continuously. For patients presenting with sepsis, early diagnosis and prompt resuscitation and early administration of anti-microbials (preferably within 1 h) and source control are desired goals. Biomarkers may help us in the diagnosis, prognosis and therapeutic monitoring of septic patients. The marker redefining our view on sepsis is yet a mirage that clinicians and researchers continue to chase.
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Affiliation(s)
- Neelmani Ahuja
- Department of Critical Care Medicine, Holy Family Hospital, Delhi 110025, India
| | - Anjali Mishra
- Department of Critical Care Medicine, Holy Family Hospital, Delhi 110025, India
| | - Ruchi Gupta
- Department of Critical Care Medicine, Holy Family Hospital, Delhi 110025, India
| | - Sumit Ray
- Department of Critical Care Medicine, Holy Family Hospital, Delhi 110025, India
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25
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Bizzoca D, Piazzolla A, Moretti L, Vicenti G, Moretti B, Solarino G. Physiologic postoperative presepsin kinetics following primary cementless total hip arthroplasty: A prospective observational study. World J Orthop 2023; 14:547-553. [PMID: 37485426 PMCID: PMC10359746 DOI: 10.5312/wjo.v14.i7.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/09/2023] [Accepted: 06/12/2023] [Indexed: 07/17/2023] Open
Abstract
BACKGROUND Presepsin is an emerging biomarker in the diagnosis of sepsis. In the field of orthopaedics, it could be useful in diagnosing and managing periprosthetic joint infections. AIM To define the normal postoperative presepsin plasmatic curve, in patients undergoing primary cementless total hip arthroplasty (THA). METHODS Patients undergoing primary cementless THA at our Institute were recruited. Inclusion criteria were: Primary osteoarthritis of the hip; urinary catheter time of permanence < 24 h; peripheral venous cannulation time of permanence < 24 h; no postoperative homologous blood transfusion administration and hospital stay ≤ 8 d. Exclusion criteria were: The presence of other articular prosthetic replacement or bone fixation devices; chronic inflammatory diseases; chronic kidney diseases; history of recurrent infections or malignant neoplasms; previous surgery in the preceding 12 mo; diabetes mellitus; immunosuppressive drug or corticosteroid assumption. All the patients received the same antibiotic prophylaxis. All the THA were performed by the same surgical and anaesthesia team; total operative time was defined as the time taken from skin incision to completion of skin closure. At enrollment, anthropometric data, smocking status, osteoarthritis stage according to Kellgren and Lawrence, Harris Hip Score, drugs assumption and comorbidities were recorded. All the patients underwent serial blood tests, including complete blood count, presepsin (PS) and C-reactive protein 24 h before arthroplasty and at 24, 48, 72 and 96 h postoperatively and at 3, 6 and 12-mo follow-up. RESULTS A total of 96 patients (51 female; 45 male; mean age = 65.74 ± 5.58) were recruited. The mean PS values were: 137.54 pg/mL at baseline, 192.08 pg/mL at 24 h post-op; 254.85 pg/mL at 48 h post-op; 259 pg/mL at 72 h post-op; 248.6 pg/mL at 96-h post-op; 140.52 pg/mL at 3-mo follow-up; 135.55 pg/mL at 6-mo follow-up and 130.11 pg/mL at 12-mo follow-up. In two patients (2.08%) a soft-tissue infection was observed; in these patients, higher levels (> 350 pg/mL) were recorded at 3-mo follow-up. CONCLUSION The dosage of plasmatic PS concentration is highly recommended in patients undergoing THA before surgery to exclude the presence of an unknown infection. The PS plasmatic concentration should be also assessed at 72 h post-operatively, evaluate the maximum postoperative PS value, and at 96 h post-operatively when a decrease of presepsin should be found. The lack of a presepsin decrease at 96 h post-operatively could be a predictive factor of infection.
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Affiliation(s)
- Davide Bizzoca
- DAI Neuroscienze, Organi di Senso e Apparato Locomotore, AOU Consorziale Policlinico di Bari, Bari 70124, Italy
| | - Andrea Piazzolla
- DAI Neuroscienze, Organi di Senso e Apparato Locomotore, AOU Consorziale Policlinico di Bari, Bari 70124, Italy
| | - Lorenzo Moretti
- DAI Neuroscienze, Organi di Senso e Apparato Locomotore, AOU Consorziale Policlinico di Bari, Bari 70124, Italy
| | | | - Biagio Moretti
- Di BraiN, University of Bari "Aldo Moro", Bari 70124, Italy
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Essmann L, Wirz Y, Gregoriano C, Schuetz P. One biomarker does not fit all: tailoring anti-infective therapy through utilization of procalcitonin and other specific biomarkers. Expert Rev Mol Diagn 2023; 23:739-752. [PMID: 37505928 DOI: 10.1080/14737159.2023.2242782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/05/2023] [Accepted: 07/27/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Considering the ongoing increase in antibiotic resistance, the importance of judicious use of antibiotics through reduction of exposure is crucial. Adding procalcitonin (PCT) and other biomarkers to pathogen-specific tests may help to further improve antibiotic therapy algorithms and advance antibiotic stewardship programs to achieve these goals. AREAS COVERED In recent years, several trials have investigated the inclusion of biomarkers such as PCT into clinical decision-making algorithms. For adult patients, findings demonstrated improvements in the individualization of antibiotic treatment, particularly for patients with respiratory tract infections and sepsis. While most trials were performed in hospitals with central laboratories, point-of-care testing might further advance the field by providing a cost-effective and rapid diagnostic tool in upcoming years. Furthermore, novel biomarkers including CD-64, presepsin, Pancreatic stone and sTREM-1, have all shown promising results for increased accuracy of sepsis diagnosis. Availability of these markers however is currently still limited and there is insufficient evidence for their routine use in clinical care. EXPERT OPINION In addition to new host-response markers, combining such biomarkers with pathogen-directed diagnostics present a promising strategy to increase algorithm accuracy in differentiating between bacterial and viral infections. Recent advances in microbiologic testing using PCR or nucleic amplification tests may further improve the diagnostic yield and promote more targeted pathogen-specific antibiotic therapy.
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Affiliation(s)
- Lennart Essmann
- Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland
| | - Yannick Wirz
- Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Philipp Schuetz
- Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland
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27
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Ren E, Xiao H, Li J, Yu H, Liu B, Wang G, Sun X, Duan M, Hang C, Zhang G, Wu C, Li F, Zhang H, Zhang Y, Guo W, Qi W, Yin Q, Zhao Y, Xie M, Li C. CLINICAL CHARACTERISTICS AND PREDICTORS OF MORTALITY DIFFER BETWEEN PULMONARY AND ABDOMINAL SEPSIS. Shock 2023; 60:42-50. [PMID: 37267265 DOI: 10.1097/shk.0000000000002151] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
ABSTRACT Background: Pulmonary sepsis and abdominal sepsis have pathophysiologically distinct phenotypes. This study aimed to compare their clinical characteristics and predictors of mortality. Methods: In this multicenter retrospective trial, 1,359 adult patients who fulfilled the Sepsis-3 criteria were enrolled and classified into the pulmonary sepsis or abdominal sepsis groups. Plasma presepsin was measured, and the scores of Acute Physiology and Chronic Health Evaluation (APACHE) II, Mortality in Emergency Department Sepsis (MEDS), and Simplified Acute Physiology Score (SAPS) II were calculated at enrollment. Data on 28-day mortality were collected for all patients. Results: Compared with patients with abdominal sepsis (n = 464), patients with pulmonary sepsis (n = 895) had higher 28-day mortality rate, illness severity scores, incidence of shock and acute kidney injury, and hospitalization costs. Lactate level and APACHE II and MEDS scores were independently associated with 28-day mortality in both sepsis types. Independent predictors of 28-day mortality included Pa o2 /F io2 ratio (hazard ratio [HR], 0.998; P < 0.001) and acute kidney injury (HR, 1.312; P = 0.039) in pulmonary sepsis, and SAPS II (HR, 1.037; P = 0.017) in abdominal sepsis. A model that combined APACHE II score, lactate, and MEDS score or SAPS II score had the best area under the receiver operating characteristic curve in predicting mortality in patients with pulmonary sepsis or abdominal sepsis, respectively. Interaction term analysis confirmed the association between 28-day mortality and lactate, APACHE II score, MEDS score, SAPS II score, and shock according to the sepsis subgroups. The mortality of patients with pulmonary sepsis was higher than that of patients with abdominal sepsis among patients without shock (32.9% vs. 8.8%; P < 0.001) but not among patients with shock (63.7 vs. 48.4%; P = 0.118). Conclusions: Patients with pulmonary sepsis had higher 28-day mortality than patients with abdominal sepsis. The study identified sepsis subgroup-specific mortality predictors. Shock had a larger effect on mortality in patients with abdominal sepsis than in those with pulmonary sepsis.
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Affiliation(s)
- Enfeng Ren
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hongli Xiao
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jiebin Li
- Department of Emergency Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Han Yu
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Bo Liu
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Guoxing Wang
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xuelian Sun
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chenchen Hang
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Guoqiang Zhang
- Department of Emergency Medicine, China-Japan Friendship Hospital, Peking Union Medical College, Beijing, China
| | - Caijun Wu
- Department of Emergency Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Fengjie Li
- Department of Emergency Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Haiyan Zhang
- Department of Emergency Medicine, The Hospital of Shunyi District Beijing, China Medical University, Beijing, China
| | - Yun Zhang
- Department of Emergency Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wei Guo
- Department of Emergency Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenjie Qi
- Department of Infectious Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qin Yin
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yunzhou Zhao
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Miaorong Xie
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chunsheng Li
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Liang J, Cai Y, Shao Y. Comparison of presepsin and Mid-regional pro-adrenomedullin in the diagnosis of sepsis or septic shock: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:288. [PMID: 37147598 PMCID: PMC10160726 DOI: 10.1186/s12879-023-08262-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/17/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND The early diagnosis of sepsis is hampered by the lack of reliable laboratory measures. There is growing evidence that presepsin and Mid-regional pro-adrenomedullin (MR-proADM) are promising biomarkers in the diagnosis of sepsis. This study was conducted to evaluate and compare the diagnostic value of MR-proADM and presepsin in sepsis patients. METHODS We searched Web of Science, PubMed, Embase, China national knowledge infrastructure, and Wanfang up to 22th July, 2022, for studies evaluating the diagnosis performance of presepsin and MR-proADM in adult sepsis patients. Risk of bias was assessed using quadas-2. Pooled sensitivity and specificity were calculated using bivariate meta-analysis. Meta-regression and subgroup analysis were used to find source of heterogeneity. RESULTS A total of 40 studies were eventually selected for inclusion in this meta-analysis, including 33 for presepsin and seven for MR-proADM. Presepsin had a sensitivity of 0.86 (0.82-0.90), a specificity of 0.79 (0.71-0.85), and an AUC of 0.90 (0.87-0.92). The sensitivity of MR-proADM was 0.84 (0.78-0.88), specificity was 0.86 (0.79-0.91), and AUC was 0.91 (0.88-0.93). The profile of control group, population, and standard reference may be potential sources of heterogeneity. CONCLUSIONS This meta-analysis demonstrated that presepsin and MR-proADM exhibited high accuracy (AUC ≥ 0.90) in the diagnosis of sepsis in adults, with MR-proADM showing significantly higher accuracy than presepsin.
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Affiliation(s)
- Jun Liang
- Department of Emergency, the First People's Hospital of Zhaoqing, Zhaoqing City, China
| | - Yingli Cai
- Department of Emergency, the First People's Hospital of Zhaoqing, Zhaoqing City, China
| | - Yiming Shao
- Jinan University, No.601, West Huangpu Avenue, Guangzhou, 510632, China.
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Aliu-Bejta A, Kurshumliu M, Namani S, Dreshaj S, Baršić B. Ability of presepsin concentrations to predict mortality in adult patients with sepsis. J Clin Transl Sci 2023; 7:e121. [PMID: 37313382 PMCID: PMC10260338 DOI: 10.1017/cts.2023.538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 06/15/2023] Open
Abstract
Background Early diagnosis of sepsis is essential for a favorable disease outcome. The aim of this study was to evaluate the association of initial and subsequent presepsin concentrations with sepsis outcomes. Methods One hundred sepsis patients were enrolled in the study from two different university centers. Four times during study, concentrations of presepsin, procalcitonin (PCT), and C-reactive protein (CRP) were measured, and Sequential Organ Failure Assessment (SOFA) score and Acute Physiology and Chronic Health Evaluation (APACHE II) score were calculated. Patients were grouped into survivors and nonsurvivors. A sandwich ELISA kit was used to measure presepsin concentrations. To test the changes in biomarkers concentrations and SOFA score and APACHE II score during the disease course and to estimate the differences between outcome groups, generalized linear mixed effects model was used. Receiver operating characteristic curve analysis was performed to determine the prognostic value of presepsin concentrations. Results Initial values of presepsin, SOFA score, and APACHE II score were significantly higher in nonsurvivors compared to survivors. Concentrations of PCT and CRP did not differ significantly between outcome groups. ROC curve analyses show a greater predictive ability of initial presepsin concentrations for predicting mortality compared to subsequent measurements of presepsin concentrations. Conclusions Presepsin has a good ability to predict mortality. Initial presepsin concentrations better reflects poor disease outcome compared to presepsin concentrations 24 and 72 hours after admission.
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Affiliation(s)
- Ajete Aliu-Bejta
- University Clinic of Infectious Diseases, Alexander Fleming, Pristina, 10000, Kosovo
- University of Pristina “Hasan Prishtina”, Faculty of Medicine, Lagja e spitalit, p.n, Pristina, 10000, Kosovo
| | - Mentor Kurshumliu
- “PROLAB” Biochemical Laboratory, Mark Dizdari, Pristina, 10000, Kosovo
| | - Sadie Namani
- University Clinic of Infectious Diseases, Alexander Fleming, Pristina, 10000, Kosovo
- University of Pristina “Hasan Prishtina”, Faculty of Medicine, Lagja e spitalit, p.n, Pristina, 10000, Kosovo
| | - Shemsedin Dreshaj
- University Clinic of Infectious Diseases, Alexander Fleming, Pristina, 10000, Kosovo
- University of Pristina “Hasan Prishtina”, Faculty of Medicine, Lagja e spitalit, p.n, Pristina, 10000, Kosovo
| | - Bruno Baršić
- University of Zagreb, School of Medicine, Šalata 4, Zagreb, 10000, Croatia
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević,”Zagreb, 10000, Croatia
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Zhang HY, Xiao HL, Wang GX, Lu ZQ, Xie MR, Li CS. Predictive value of presepsin and acylcarnitines for severity and biliary drainage in acute cholangitis. World J Gastroenterol 2023; 29:2502-2514. [PMID: 37179587 PMCID: PMC10167903 DOI: 10.3748/wjg.v29.i16.2502] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/21/2023] [Accepted: 03/31/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Bacteremia, which is a major cause of mortality in patients with acute cholangitis, induces hyperactive immune response and mitochondrial dysfunction. Presepsin is responsible for pathogen recognition by innate immunity. Acylcarnitines are established mitochondrial biomarkers. AIM To clarify the early predictive value of presepsin and acylcarnitines as biomarkers of severity of acute cholangitis and the need for biliary drainage. METHODS Of 280 patients with acute cholangitis were included and the severity was stratified according to the Tokyo Guidelines 2018. Blood presepsin and plasma acylcarnitines were tested at enrollment by chemiluminescent enzyme immunoassay and ultra-high-performance liquid chromatography-mass spectrometry, respectively. RESULTS The concentrations of presepsin, procalcitonin, short- and medium-chain acylcarnitines increased, while long-chain acylcarnitines decreased with the severity of acute cholangitis. The areas under the receiver operating characteristic curves (AUC) of presepsin for diagnosing moderate/severe and severe cholangitis (0.823 and 0.801, respectively) were greater than those of conventional markers. The combination of presepsin, direct bilirubin, alanine aminotransferase, temperature, and butyryl-L-carnitine showed good predictive ability for biliary drainage (AUC: 0.723). Presepsin, procalcitonin, acetyl-L-carnitine, hydroxydodecenoyl-L-carnitine, and temperature were independent predictors of bloodstream infection. After adjusting for severity classification, acetyl-L-carnitine was the only acylcarnitine independently associated with 28-d mortality (hazard ratio 14.396; P < 0.001) (AUC: 0.880). Presepsin concentration showed positive correlation with direct bilirubin or acetyl-L-carnitine. CONCLUSION Presepsin could serve as a specific biomarker to predict the severity of acute cholangitis and need for biliary drainage. Acetyl-L-carnitine is a potential prognostic factor for patients with acute cholangitis. Innate immune response was associated with mitochondrial metabolic dysfunction in acute cholangitis.
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Affiliation(s)
- Han-Yu Zhang
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Hong-Li Xiao
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Guo-Xing Wang
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Zhao-Qing Lu
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Miao-Rong Xie
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Chun-Sheng Li
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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Turgman O, Schinkel M, Wiersinga WJ. Host Response Biomarkers for Sepsis in the Emergency Room. Crit Care 2023; 27:97. [PMID: 36941681 PMCID: PMC10027585 DOI: 10.1186/s13054-023-04367-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2023. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2023 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from https://link.springer.com/bookseries/8901 .
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Affiliation(s)
- Oren Turgman
- Center for Experimental and Molecular Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Michiel Schinkel
- Center for Experimental and Molecular Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Division of Infectious Diseases, Department of Medicine, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Willem Joost Wiersinga
- Center for Experimental and Molecular Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
- Division of Infectious Diseases, Department of Medicine, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Presepsin as a diagnostic and prognostic biomarker of severe bacterial infections and COVID-19. Sci Rep 2023; 13:3814. [PMID: 36882572 PMCID: PMC9990570 DOI: 10.1038/s41598-023-30807-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/01/2023] [Indexed: 03/09/2023] Open
Abstract
We aimed to develop presepsin as a marker of diagnosis of severe infections of either bacterial and viral origin. The derivation cohort was recruited from 173 hospitalized patients with acute pancreatitis or post-operative fever or infection suspicion aggravated by at least one sign of the quick sequential organ failure assessment (qSOFA). The first validation cohort was recruited from 57 admissions at the emergency department with at least one qSOFA sign and the second validation cohort from 115 patients with COVID-19 pneumonia. Presepsin was measured in plasma by the PATHFAST assay. Concentrations more than 350 pg/ml had sensitivity 80.2% for sepsis diagnosis in the derivation cohort (adjusted odds ratio 4.47; p < 0.0001). In the derivation cohort, sensitivity for 28-day mortality prognosis was 91.5% (adjusted odds ratio 6.82; p: 0.001). Concentrations above 350 pg/ml had sensitivity 93.3% for the diagnosis of sepsis in the first validation cohort; this was 78.3% in the second validation cohort of COVID-19 aiming at the early diagnosis of acute respiratory distress syndrome necessitating mechanical ventilation. The respective sensitivity for 28-day mortality was 85.7% and 92.3%. Presepsin may be a universal biomarker for the diagnosis of severe infections of bacterial origin and prediction of unfavorable outcome.
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Han S, Kim MJ, Ko HJ, Lee EJ, Kim HR, Jeon JW, Ham YR, Na KR, Lee KW, Lee SI, Choi DE, Park H. Diagnostic and Prognostic Roles of C-Reactive Protein, Procalcitonin, and Presepsin in Acute Kidney Injury Patients Initiating Continuous Renal Replacement Therapy. Diagnostics (Basel) 2023; 13:diagnostics13040777. [PMID: 36832265 PMCID: PMC9955569 DOI: 10.3390/diagnostics13040777] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/11/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
For reducing the high mortality rate of severe acute kidney injury (AKI) patients initiating continuous renal replacement therapy (CRRT), diagnosing sepsis and predicting prognosis are essential. However, with reduced renal function, biomarkers for diagnosing sepsis and predicting prognosis are unclear. This study aimed to assess whether C-reactive protein (CRP), procalcitonin, and presepsin could be used to diagnose sepsis and predict mortality in patients with impaired renal function initiating CRRT. This was a single-center, retrospective study involving 127 patients who initiated CRRT. Patients were divided into sepsis and non-sepsis groups according to the SEPSIS-3 criteria. Of the 127 patients, 90 were in the sepsis group and 37 were in the non-sepsis group. Cox regression analysis was performed to determine the association between the biomarkers (CRP, procalcitonin, and presepsin) and survival. CRP and procalcitonin were superior to presepsin for diagnosing sepsis. Presepsin was closely related to the estimated glomerular filtration rate (eGFR) (r = -0.251, p = 0.004). These biomarkers were also evaluated as prognostic markers. Procalcitonin levels ≥3 ng/mL and CRP levels ≥31 mg/L were associated with higher all-cause mortality using Kaplan-Meier curve analysis. (log-rank test p = 0.017 and p = 0.014, respectively). In addition, procalcitonin levels ≥3 ng/mL and CRP levels ≥31 mg/L were associated with higher mortality in univariate Cox proportional hazards model analysis. In conclusion, a higher lactic acid, sequential organ failure assessment score, eGFR, and a lower albumin level have prognostic value to predict mortality in patients with sepsis initiating CRRT. Moreover, among these biomarkers, procalcitonin and CRP are significant factors for predicting the survival of AKI patients with sepsis-initiating CRRT.
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Affiliation(s)
- Suyeon Han
- Department of Nephrology, Chungnam National University Hospital, Daejeon 35015, Republic of Korea
| | - Moo-Jun Kim
- Department of Nephrology, Chungnam National University Hospital, Daejeon 35015, Republic of Korea
| | - Ho-Joon Ko
- Department of Nephrology, Chungnam National University Hospital, Daejeon 35015, Republic of Korea
| | - Eu-Jin Lee
- Department of Nephrology, Chungnam National University Hospital, Daejeon 35015, Republic of Korea
| | - Hae-Ri Kim
- Department of Nephrology, Chungnam National University Sejong Hospital, Sejong 30099, Republic of Korea
| | - Jae-Wan Jeon
- Department of Nephrology, Chungnam National University Sejong Hospital, Sejong 30099, Republic of Korea
| | - Young-Rok Ham
- Department of Nephrology, Chungnam National University Hospital, Daejeon 35015, Republic of Korea
| | - Ki-Ryang Na
- Department of Nephrology, Chungnam National University Hospital, Daejeon 35015, Republic of Korea
| | - Kang-Wook Lee
- Department of Nephrology, Chungnam National University Hospital, Daejeon 35015, Republic of Korea
| | - Song-I. Lee
- Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Daejeon 35015, Republic of Korea
- Correspondence: (S.-I.L.); (D.-E.C.)
| | - Dae-Eun Choi
- Department of Nephrology, Chungnam National University Hospital, Daejeon 35015, Republic of Korea
- Department of Medical Science, Medical School, Chungnam National University, Daejeon 35015, Republic of Korea
- Correspondence: (S.-I.L.); (D.-E.C.)
| | - Heyrim Park
- Department of Medical Science, Medical School, Chungnam National University, Daejeon 35015, Republic of Korea
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Imai Y, Tanaka R, Honda K, Matsuo K, Taniguchi K, Asakuma M, Lee SW. The usefulness of presepsin in the diagnosis of postoperative infectious complications after gastrectomy for gastric cancer: a prospective cohort study. Sci Rep 2022; 12:21289. [PMID: 36494434 PMCID: PMC9734175 DOI: 10.1038/s41598-022-24780-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
This prospective study aimed to evaluate presepsin use as a biomarker of on postoperative infectious complications after gastrectomy, compared to C-reactive protein (CRP), white blood cells (WBCs), and neutrophils (Neuts). Overall, 108 patients were enrolled between October 2019 and December 2020. Presepsin, CRP, WBC, and Neut levels were measured preoperatively and on postoperative days (PODs) 1, 3, 5, and 7, using a postoperative morbidity survey. Grade II or higher infectious complications occurred in 18 patients (16.6%). Presepsin levels on all evaluated PODs were significantly higher in the infectious complication group than in the non-complication group (p = 0.002, p < 0.0001, p < 0.0001, and p = 0.025, respectively). The area under the curve (AUC) values were the highest for presepsin on PODs 3 and 7 (0.89 and 0.77, respectively) and similar to that of CRP, with a high value > 0.8 (0.86) on POD 5. For presepsin, the optimal cut-off values were 298 pg/mL (sensitivity, 83.3%; specificity, 83.3%), 278 pg/mL (sensitivity, 83.3%; specificity, 82.2%), and 300 pg/mL (sensitivity, 83.3%; specificity, 82%) on PODs 3, 5, and 7, respectively. Presepsin levels on PODs 3, 5, and 7 after gastrectomy is a more useful biomarker of postoperative infectious complications compared to CRP, WBCs, and Neuts, with a high sensitivity and specificity.
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Affiliation(s)
- Yoshiro Imai
- Departments of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Ryo Tanaka
- Departments of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Kotaro Honda
- Departments of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Kentaro Matsuo
- Departments of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Kohei Taniguchi
- Department of Translational Research Program, Faculty of Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Mitsuhiro Asakuma
- Departments of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Sang-Woong Lee
- Departments of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
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Lee JH, Kim SH, Jang JH, Park JH, Jo KM, No TH, Jang HJ, Lee HK. Clinical usefulness of biomarkers for diagnosis and prediction of prognosis in sepsis and septic shock. Medicine (Baltimore) 2022; 101:e31895. [PMID: 36482619 PMCID: PMC9726295 DOI: 10.1097/md.0000000000031895] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/27/2022] [Indexed: 12/13/2022] Open
Abstract
Sepsis is a life-threatening condition and remains a major cause of mortality. The aim of this study was to evaluate the role of biomarkers in the diagnosis of sepsis and septic shock in patients admitted to the emergency department (ED). Medical records of patients who underwent measurement of serum biomarkers including lactic acid, C-reactive protein, procalcitonin (PCT), and presepsin in the ED between May 2019 and May 2020 were retrospectively reviewed. Patients were subdivided into 3 groups; non-sepsis, sepsis, and septic shock according to the new definition using the sequential organ failure assessment score. The mean age was 69.3 years, and 55.8% of the study population was female. Of 249 subjects, 98 patients confined to sepsis group, and 35.7% of them were septic shock. In the multivariable analysis, a high level of PCT was an independent predictor of sepsis (odds ratio [OR], 1.028; 95% confidence interval [CI], 1.006-1.051; P = .011) along with a simplified acute physiology score III (SAPS III) (OR, 1.082; 95% CI, 1.062-1.103, P < .001). PCT was also an independent risk factor for septic shock (OR, 1.043; 95% CI, 1.016-1.071, P = .02). In the receiver operating characteristic curve analysis, the area under the curve of PCT to predict sepsis and septic shock were 0.691 (P < .001) and 0.734 (P < .001), respectively. The overall 30-days mortality rate was 8.8%, and the mortality rate was significantly higher in the sepsis group (sepsis vs non-sepsis, 15.3% vs 4.6%; P = .004). In the multivariate Cox analysis, a higher level of lactic acid (hazard ratio [HR], 1.328; 95% CI, 1.061-1.663, P = .013), predisposing chronic pulmonary diseases (HR, 7.035; 95% CI, 1.687-29.341, P = .007), and a high SAPSIII value (HR, 1.046; 95% CI, 1.015-1.078, P = .003) were independent risk factors for mortality in sepsis patients. PCT was a useful biomarker for predicting sepsis and septic shock in the ED. A higher level of lactic acid, predisposing chronic pulmonary diseases, and a high SAPS III score were associated with a greater mortality risk in patients with sepsis.
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Affiliation(s)
- Jae Ha Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Seong-Ho Kim
- Division of Rheumatology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Ji Hoon Jang
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jin Han Park
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Kyung Min Jo
- Division of Infectious diseases, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Tae-Hoon No
- Division of Infectious diseases, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Hang-Jea Jang
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Hyun-Kyung Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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Kim CJ. Current Status of Antibiotic Stewardship and the Role of Biomarkers in Antibiotic Stewardship Programs. Infect Chemother 2022; 54:674-698. [PMID: 36596680 PMCID: PMC9840952 DOI: 10.3947/ic.2022.0172] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/19/2022] [Indexed: 12/27/2022] Open
Abstract
The importance of antibiotic stewardship is increasingly emphasized in accordance with the increasing incidences of multidrug-resistant organisms and accompanying increases in disease burden. This review describes the obstacles in operating an antibiotic stewardship program (ASP), and whether the use of biomarkers within currently available resources can help. Surveys conducted around the world have shown that major obstacles to ASPs are shortages of time and personnel, lack of appropriate compensation for ASP operation, and lack of guidelines or appropriate manuals. Sufficient investment, such as the provision of full-time equivalent ASP practitioners, and adoption of computerized clinical decision systems are useful measures to improve ASP within an institution. However, these methods are not easy in terms of both time commitments and cost. Some biomarkers, such as C-reactive protein, procalcitonin, and presepsin are promising tools in ASP due to their utility in diagnosis and forecasting the prognosis of sepsis. Recent studies have demonstrated the usefulness of algorithmic approaches based on procalcitonin level to determine the initiation or discontinuation of antibiotics, which would be helpful in decreasing antibiotics use, resulting in more appropriate antibiotics use.
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Affiliation(s)
- Chung-Jong Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
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Xiao HL, Wang GX, Wang Y, Tan ZM, Zhou J, Yu H, Xie MR, Li CS. Dynamic blood presepsin levels are associated with severity and outcome of acute pancreatitis: A prospective cohort study. World J Gastroenterol 2022; 28:5203-5216. [PMID: 36188715 PMCID: PMC9516673 DOI: 10.3748/wjg.v28.i35.5203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/10/2022] [Accepted: 09/01/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is an inflammatory disorder of the pancreas with an unpredictable course of illness. A major challenge of AP is the early identification of patients at high-risk for organ failure and death. However, scoring systems are complicated and time consuming, and the predictive values for the clinical course are vague.
AIM To determine whether the dynamic changes in presepsin levels can be used to evaluate the severity of disease and outcome of AP.
METHODS In this multicentric cohort study, 133 patients with AP were included. Clinical severity was dynamically evaluated using the 2012 revised Atlanta Classification. Blood presepsin levels were measured at days 1, 3, 5 and 7 after admission by chemiluminescent enzyme immunoassay.
RESULTS The median concentration of presepsin increased and the clearance rate of presepsin decreased with disease severity and organ failure in AP patients. The presepsin levels on days 3, 5 and 7 were independent predictors of moderately severe and severe AP with time-specific area under the curve (AUC) values of 0.827, 0.848 and 0.867, respectively. The presepsin levels positively correlated with bedside index of severity in AP, Ranson, acute physiology and chronic health evaluation II, computed tomography severity index and Marshall scores. Presepsin levels on days 3, 5 and 7 were independent predictors of 28-d mortality of AP patients with AUC values of 0.781, 0.846 and 0.843, respectively.
CONCLUSION Blood presepsin levels within 7 d of admission were associated with and may be useful to dynamically predict the severity of disease course and 28-d mortality in AP patients.
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Affiliation(s)
- Hong-Li Xiao
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Guo-Xing Wang
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Yan Wang
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Zhi-Min Tan
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Jie Zhou
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Han Yu
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Miao-Rong Xie
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Chun-Sheng Li
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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Davoudian S, Piovani D, Desai A, Mapelli SN, Leone R, Sironi M, Valentino S, Silva-Gomes R, Stravalaci M, Asgari F, Madera A, Piccinini D, Fedeli C, Comina D, Bonovas S, Voza A, Mantovani A, Bottazzi B. A cytokine/PTX3 prognostic index as a predictor of mortality in sepsis. Front Immunol 2022; 13:979232. [PMID: 36189302 PMCID: PMC9521428 DOI: 10.3389/fimmu.2022.979232] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/29/2022] [Indexed: 12/15/2022] Open
Abstract
BackgroundEarly prognostic stratification of patients with sepsis is a difficult clinical challenge. Aim of this study was to evaluate novel molecules in association with clinical parameters as predictors of 90-days mortality in patients admitted with sepsis at Humanitas Research Hospital.MethodsPlasma samples were collected from 178 patients, diagnosed based on Sepsis-3 criteria, at admission to the Emergency Department and after 5 days of hospitalization. Levels of pentraxin 3 (PTX3), soluble IL-1 type 2 receptor (sIL-1R2), and of a panel of pro- and anti-inflammatory cytokines were measured by ELISA. Cox proportional-hazard models were used to evaluate predictors of 90-days mortality.ResultsCirculating levels of PTX3, sIL-1R2, IL-1β, IL-6, IL-8, IL-10, IL-18, IL-1ra, TNF-α increased significantly in sepsis patients on admission, with the highest levels measured in shock patients, and correlated with SOFA score (PTX3: r=0.44, p<0.0001; sIL-1R2: r=0.35, p<0.0001), as well as with 90-days mortality. After 5 days of hospitalization, PTX3 and cytokines, but not sIL-1R2 levels, decreased significantly, in parallel with a general improvement of clinical parameters. The combination of age, blood urea nitrogen, PTX3, IL-6 and IL-18, defined a prognostic index predicting 90-days mortality in Sepsis-3 patients and showing better apparent discrimination capacity than the SOFA score (AUC=0.863, 95% CI: 0.780−0.945 vs. AUC=0.727, 95% CI: 0.613-0.840; p=0.021 respectively).ConclusionThese data suggest that a prognostic index based on selected cytokines, PTX3 and clinical parameters, and hence easily adoptable in clinical practice, performs in predicting 90-days mortality better than SOFA. An independent validation is required.
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Affiliation(s)
- Sadaf Davoudian
- Department of Research in Inflammation and Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Daniele Piovani
- Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Antonio Desai
- Department of Biomedical Science, Humanitas University, Milan, Italy
- Department of Emergency, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Sarah N. Mapelli
- Department of Research in Inflammation and Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Roberto Leone
- Department of Research in Inflammation and Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Marina Sironi
- Department of Research in Inflammation and Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Sonia Valentino
- Department of Research in Inflammation and Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Rita Silva-Gomes
- Department of Research in Inflammation and Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Matteo Stravalaci
- Department of Research in Inflammation and Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Fatemeh Asgari
- Department of Research in Inflammation and Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Alessandra Madera
- Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Daniele Piccinini
- Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Carlo Fedeli
- Department of Emergency, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Denise Comina
- Department of Emergency, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Stefanos Bonovas
- Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Antonio Voza
- Department of Biomedical Science, Humanitas University, Milan, Italy
- Department of Emergency, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Alberto Mantovani
- Department of Research in Inflammation and Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Science, Humanitas University, Milan, Italy
- The William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- *Correspondence: Barbara Bottazzi, ; Alberto Mantovani,
| | - Barbara Bottazzi
- Department of Research in Inflammation and Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
- *Correspondence: Barbara Bottazzi, ; Alberto Mantovani,
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Madushani RWMA, Patel V, Loftus T, Ren Y, Li HJ, Velez L, Wu Q, Adhikari L, Efron P, Segal M, Ozrazgat-Baslanti T, Rashidi P, Bihorac A. Early Biomarker Signatures in Surgical Sepsis. J Surg Res 2022; 277:372-383. [PMID: 35569215 PMCID: PMC9827429 DOI: 10.1016/j.jss.2022.04.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/20/2022] [Accepted: 04/08/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Sepsis has complex, time-sensitive pathophysiology and important phenotypic subgroups. The objective of this study was to use machine learning analyses of blood and urine biomarker profiles to elucidate the pathophysiologic signatures of subgroups of surgical sepsis patients. METHODS This prospective cohort study included 243 surgical sepsis patients admitted to a quaternary care center between January 2015 and June 2017. We applied hierarchical clustering to clinical variables and 42 blood and urine biomarkers to identify phenotypic subgroups in a development cohort. Clinical characteristics and short-term and long-term outcomes were compared between clusters. A naïve Bayes classifier predicted cluster labels in a validation cohort. RESULTS The development cohort contained one cluster characterized by early organ dysfunction (cluster I, n = 18) and one cluster characterized by recovery (cluster II, n = 139). Cluster I was associated with higher Acute Physiologic Assessment and Chronic Health Evaluation II (30 versus 16, P < 0.001) and SOFA scores (13 versus 5, P < 0.001), greater prevalence of chronic cardiovascular and renal disease (P < 0.001) and septic shock (78% versus 17%, P < 0.001). Cluster I had higher mortality within 14 d of sepsis onset (11% versus 1.5%, P = 0.001) and within 1 y (44% versus 20%, P = 0.032), and higher incidence of chronic critical illness (61% versus 30%, P = 0.001). The Bayes classifier achieved 95% accuracy and identified two clusters that were similar to development cohort clusters. CONCLUSIONS Machine learning analyses of clinical and biomarker variables identified an early organ dysfunction sepsis phenotype characterized by inflammation, renal dysfunction, endotheliopathy, and immunosuppression, as well as poor short-term and long-term clinical outcomes.
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Affiliation(s)
- R W M A Madushani
- University of Florida, Intelligent Critical Care Center, Gainesville, FL; Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida
| | - Vishal Patel
- Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida
| | - Tyler Loftus
- University of Florida, Intelligent Critical Care Center, Gainesville, FL; Department of Surgery, University of Florida, Gainesville, Florida
| | - Yuanfang Ren
- University of Florida, Intelligent Critical Care Center, Gainesville, FL; Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida
| | - Han Jacob Li
- Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida
| | - Laura Velez
- Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida
| | - Quran Wu
- Department of Surgery, University of Florida, Gainesville, Florida; Sepsis and Critical Illness Research Center, University of Florida, Gainesville, Florida
| | - Lasith Adhikari
- University of Florida, Intelligent Critical Care Center, Gainesville, FL; Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida
| | - Philip Efron
- Department of Surgery, University of Florida, Gainesville, Florida; Sepsis and Critical Illness Research Center, University of Florida, Gainesville, Florida
| | - Mark Segal
- Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida; Sepsis and Critical Illness Research Center, University of Florida, Gainesville, Florida
| | - Tezcan Ozrazgat-Baslanti
- University of Florida, Intelligent Critical Care Center, Gainesville, FL; Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida; Sepsis and Critical Illness Research Center, University of Florida, Gainesville, Florida
| | - Parisa Rashidi
- University of Florida, Intelligent Critical Care Center, Gainesville, FL; J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Azra Bihorac
- University of Florida, Intelligent Critical Care Center, Gainesville, FL; Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida; Sepsis and Critical Illness Research Center, University of Florida, Gainesville, Florida.
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Park J, Yoon JH, Ki HK, Ko JH, Moon HW. Performance of presepsin and procalcitonin predicting culture-proven bacterial infection and 28-day mortality: A cross sectional study. Front Med (Lausanne) 2022; 9:954114. [PMID: 36072944 PMCID: PMC9441687 DOI: 10.3389/fmed.2022.954114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/02/2022] [Indexed: 11/29/2022] Open
Abstract
Presepsin is a highly specific biomarker for diagnosing bacterial infections, but its clinical usefulness is not well validated. A retrospective cross-sectional study was conducted. Among the patients suspected bacterial infection or fulfilled the criteria of systemic inflammatory response syndrome (SIRS) and patients who underwent blood culture, presepsin, procalcitonin (PCT), and C-reactive protein (CRP) at the same time were included. Receiver operating characteristic (ROC) curve analysis and logistic regression were used to compare performance of three biomarkers. A total of 757 patients were enrolled, including 256 patients (33.8%) with culture-proven bacterial infection and 109 patients (14.4%) with bacteremia. The 28-day mortality rate was 8.6%. ROC curve analysis revealed that the area under the curve (AUC) of PCT was higher than that of presepsin for both culture-proven bacterial infection (0.665 and 0.596, respectively; p = 0.003) and bacteremia (0.791 and 0.685; p < 0.001). In contrast, AUC of PCT for 28-day mortality was slower than presepsin (0.593 and 0.720; p = 0.002). In multivariable logistic regression analysis, PCT showed the highest ORs for culture-proven bacterial infection (OR 2.23, 95% CI 1.55–3.19; p < 0.001) and for bacteremia (OR 5.18, 95% CI 3.13–8.56; p < 0.001), while presepsin showed the highest OR for 28-day mortality (OR 3.31, 95% CI 1.67–6.54; p < 0.001). CRP did not show better performance than PCT or presepsin in any of the analyses. PCT showed the best performance predicting culture-proven bacterial infection and bacteremia, while presepsin would rather be useful as a prognostic marker.
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Affiliation(s)
- Jiho Park
- Division of Infectious Diseases, Department of Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Ji Hyun Yoon
- Division of Infectious Diseases, Department of Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Hyun Kyun Ki
- Division of Infectious Diseases, Department of Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Jae-Hoon Ko
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- *Correspondence: Jae-Hoon Ko,
| | - Hee-Won Moon
- Department of Laboratory Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
- Hee-Won Moon,
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Kang T, Yoo J, Choi H, Lee S, Jekarl DW, Kim Y. Performance evaluation of presepsin using a Sysmex
HISCL
‐5000 analyzer and determination of reference interval. J Clin Lab Anal 2022; 36:e24618. [PMID: 35870180 PMCID: PMC9459287 DOI: 10.1002/jcla.24618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 12/26/2022] Open
Abstract
Background Analytical evaluation of newly developed presepsin by a Sysmex HISCL‐5000 (Sysmex, Japan) automated immune analyzer was performed. Methods For evaluation, sepsis patient samples were collected before treatment in an emergency department. Precision, linearity, limit of blank/limit of detection, method comparisons, and reference intervals were evaluated. Method comparisons were performed using a PATHFAST immune analyzer (LSI Medience Corporation, Japan). Results Precision using a 20x2x2 protocol for low (306 pg/mL) and high (1031 pg/mL) levels resulted in within‐laboratory standard deviation (95% confidence interval [CI]) and coefficient of variation (CV) %, which were as follows: 15.3 (13.1–18.7), 5.5% and 47.7, (40.5–58.1), 6.4%, respectively. Linearity using patient samples and calibrators were measured from 201 to 16,177 and 188 to 30,000 pg/mL, respectively. The regression equation was y = −23.2 + 1.008x (SE = 162.4) for low levels and y = 779.9 + 1.006x (SE = 668) for high levels. Method comparison by Passing–Bablock analysis was as follows: y = −209.77 + 1.047x (Syx = 335.3). The correlation coefficient (95% CI) was 0.869 (0.772–0.927) with statistical significance (p < 0.001). Reference intervals from 120 normal healthy subjects showed that 300 pg/mL was the cut off. Presepsin tended to show a higher value at higher ages and in males. Presepsin showed correlation with some parameters, and the correlation coefficient (p value) were as follows: hematocrit, 0.198 (0.03); eGFR (CKD‐EPI), −0.240 (0.0129); MDRD‐eGFR, −0.194 (0.048), respectively. Conclusion Presepsin measurement by HISCL‐5000 showed reliable performance. Further clinical studies are required for the diagnosis and prognosis of sepsis.
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Affiliation(s)
- Taewon Kang
- Departement of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine The Catholic University of Korea Seoul South Korea
- Research and Development Institute for In Vitro Diagnostic Medical Devices of Catholic University of Korea, College of Medicine The Catholic University of Korea Seoul South Korea
| | - Jeaeun Yoo
- Departement of Laboratory Medicine, Incheon St. Mary's Hospital, College of Medicine The Catholic University of Korea Seoul South Korea
| | - Hyunyu Choi
- Departement of Laboratory Medicine, Incheon St. Mary's Hospital, College of Medicine The Catholic University of Korea Seoul South Korea
| | - Seungok Lee
- Departement of Laboratory Medicine, Incheon St. Mary's Hospital, College of Medicine The Catholic University of Korea Seoul South Korea
| | - Dong Wook Jekarl
- Departement of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine The Catholic University of Korea Seoul South Korea
- Research and Development Institute for In Vitro Diagnostic Medical Devices of Catholic University of Korea, College of Medicine The Catholic University of Korea Seoul South Korea
| | - Yonggoo Kim
- Departement of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine The Catholic University of Korea Seoul South Korea
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Biomarkers of sepsis in pigs, horses and cattle: from acute phase proteins to procalcitonin. Anim Health Res Rev 2022; 23:82-99. [PMID: 35795920 DOI: 10.1017/s1466252322000019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Sepsis is a complex clinical syndrome triggered by an inflammatory host response to an infection. It is usually complicated to detect and diagnose, and has severe consequences in human and veterinary health, especially when treatment is not started early. Therefore, efforts to detect sepsis accurately are needed. In addition, its proper diagnosis could reduce the misuse of antibiotics, which is essential fighting against antimicrobial resistance. This case is a particular issue in farm animals, as antibiotics have been traditionally given massively, but now they are becoming increasingly restricted. When sepsis is suspected in animals, the most frequently used biomarkers are acute phase proteins such as C-reactive protein, serum amyloid A and haptoglobin, but their concentrations can increase in other inflammatory conditions. In human patients, the most promising biomarkers to detect sepsis are currently procalcitonin and presepsin, and there is a wide range of other biomarkers under study. However, there is little information on the application of these biomarkers in veterinary species. This review aims to describe the general concepts of sepsis and the current knowledge about the biomarkers of sepsis in pigs, horses, and cattle and to discuss possible advances in the field.
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Li S, Jiang H, Xing W, Wang S, Zhang Y, Li Y, Mao C, Zeng D, Lan P, Tang D, Zhan J, Li L, Xu X, Fei J. A Clinical Diagnostic Study: Fibulin-2 is a Novel Promising Biomarker for Predicting Infection. Infect Dis Ther 2022; 11:1057-1073. [PMID: 35303288 PMCID: PMC8931586 DOI: 10.1007/s40121-022-00622-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/07/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Infection remains a major cause of morbidity and mortality in hospital. As uncontrolled early infection may develop into systemic infection and eventually progress to sepsis, it is important to address infection at an early stage. Furthermore, early detection and prompt diagnosis of infection are the basis of clinical intervention. However, as a result of the interference of complex aetiologies, including fever and trauma, problems regarding the sensitivity and specificity of current diagnostic indices remain, such as for C-reactive protein (CRP), procalcitonin (PCT), white blood cells (WBC), neutrophil ratio (NEU%), interleukin-6 (IL-6) and D-dimer. As a result, there is an urgent need to develop new biomarkers to diagnose infection. METHODS From January to October 2021, consecutive patients in the emergency department (ED) were recruited to investigate the feasibility of fibulin-2 as a diagnostic indicator of early infection. Fibulin-2 concentrations in plasma were determined with enzyme-linked immunosorbent assay (ELISA). The performance of fibulin-2 for predicting infection was analysed by receiver operating characteristic (ROC) curves. RESULTS We found that the plasma fibulin-2 level was elevated in patients with infection compared with those without infection. ROC curve analysis showed that the area under the curve (AUC) for fibulin-2 was 0.712. For all patients included, the diagnostic ability of fibulin-2 (AUC 0.712) performed as well as CRP (AUC 0.667) and PCT (AUC 0.632), and better than WBC (AUC 0.620), NEU% (AUC 0.619), IL-6 (AUC 0.561) and D-dimer (AUC 0.630). In patients with fever, fibulin-2 performed as well as PCT and better than the other biomarkers in infection diagnosis. In particular, fibulin-2 performed better than all these biomarkers in patients with trauma. CONCLUSION Fibulin-2 is a novel promising diagnostic biomarker for predicting infection.
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Affiliation(s)
- Shidan Li
- Department of Orthopaedics, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Hao Jiang
- Department of Orthopaedics, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People's Republic of China
| | - Wei Xing
- Department of Stem Cell and Regenerative Medicine, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Shaochuan Wang
- Department of Orthopaedics, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Yao Zhang
- Department of Epidemiology, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Youbin Li
- Department of Orthopaedics, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Chengyi Mao
- Department of Pathology, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Delian Zeng
- Department of Emergency, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Ping Lan
- Department of Anesthesiology, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Dongqin Tang
- Department of Emergency, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Jijie Zhan
- Department of Emergency, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Lei Li
- Department of Stem Cell and Regenerative Medicine, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Xiang Xu
- Department of Stem Cell and Regenerative Medicine, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China.
| | - Jun Fei
- Department of Emergency, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China.
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Combined Use of Presepsin and (1,3)-β-D-glucan as Biomarkers for Diagnosing Candida Sepsis and Monitoring the Effectiveness of Treatment in Critically Ill Patients. J Fungi (Basel) 2022; 8:jof8030308. [PMID: 35330311 PMCID: PMC8954802 DOI: 10.3390/jof8030308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/07/2022] [Accepted: 03/14/2022] [Indexed: 11/17/2022] Open
Abstract
New biomarker panel was developed and validated on 165 critically ill adult patients to enable a more accurate invasive candidiasis (IC) diagnosis. Serum levels of the panfungal biomarker (1,3)-β-D-glucan (BDG) and the inflammatory biomarkers C-reactive protein, presepsin (PSEP), and procalcitonin (PCT) were correlated with culture-confirmed candidemia or bacteremia in 58 and 107 patients, respectively. The diagnostic utility was evaluated in sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). BDG was the best marker for IC, achieving 96.6% sensitivity, 97.2% specificity, 94.9% PPV, and 98.1% NPV at a cut-off of 200 pg/mL (p ≤ 0.001). PSEP exhibited 100% sensitivity and 100% NPV at a cut-off of 700 pg/mL but had a lower PPV (36.5%) and low specificity (5.6%). Combined use of PSEP and BDG, thus, seems to be the most powerful laboratory approach for diagnosing IC. Furthermore, PSEP was more accurate for 28-day mortality prediction the area under the receiver operating characteristic curve (AUC = 0.74) than PCT (AUC = 0.31; PCT cut-off = 0.5 ng/mL). Finally, serum PSEP levels decreased significantly after only 14 days of echinocandin therapy (p = 0.0012). The probability of IC is almost 100% in critically ill adults with serum BDG and PSEP concentrations > 200 pg/mL and >700 pg/mL, respectively, defining a borderline between non-invasive superficial Candida colonization and IC.
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Amanai E, Nakai K, Saito J, Hashiba E, Miura T, Morohashi H, Sakamoto Y, Mikami A, Hakamada K, Hirota K. Usefulness of presepsin for the early detection of infectious complications after elective colorectal surgery, compared with C-reactive protein and procalcitonin. Sci Rep 2022; 12:3960. [PMID: 35273185 PMCID: PMC8913670 DOI: 10.1038/s41598-022-06613-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/01/2022] [Indexed: 12/28/2022] Open
Abstract
Infectious complications remain a major clinical problem in colorectal surgery. Presepsin has been reported to be a useful marker to diagnose sepsis, similar or superior to procalcitonin (PCT) and C-reactive protein (CRP). The aim of this study was to assess the diagnostic value of presepsin in the early detection of infectious complications after elective colorectal surgery, compared with CRP and PCT. This study was a prospective observational study. Patients of age > 18 who underwent elective colon resections were enrolled. Blood samples were collected just before surgery and on postoperative day (POD) 1, 2, 3, 4, and 6 to measure plasma levels of biomarkers. We evaluated the association between circulating biomarkers and infections. A total of 114 patients were examined, and 27 patients (23.7%) developed infectious complications. CRP and PCT markedly increased from POD 1 to POD 3 and then gradually decreased toward POD 6 in both groups, but the trends of the decrease in the infected group were blunt, compared with those in the non-infected group. On the other hand, presepsin did not show major changes just after surgery, but it increased on POD 4 and POD 6, when the complications occurred. Monitoring the presepsin trends after colorectal surgeries could be helpful to detect postoperative infectious complications. Trial registration: UMIN000025313. Registered on 17 December 2016.
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Affiliation(s)
- Erika Amanai
- Department of Anesthesiology, Hirosaki University Hospital, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Kishiko Nakai
- Department of Anesthesiology, Hirosaki University Hospital, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
| | - Junichi Saito
- Division of Intensive Care Unit, Hirosaki University Hospital, Hirosaki, Japan
| | - Eiji Hashiba
- Division of Intensive Care Unit, Hirosaki University Hospital, Hirosaki, Japan
| | - Takuya Miura
- Department of Gastroenterological Surgery and Pediatric Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hajime Morohashi
- Department of Gastroenterological Surgery and Pediatric Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yoshiyuki Sakamoto
- Department of Gastroenterological Surgery and Pediatric Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Akio Mikami
- Central Clinical Laboratory, Hirosaki University Hospital, Hirosaki, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery and Pediatric Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kazuyoshi Hirota
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Biomarkers Predicting Tissue Pharmacokinetics of Antimicrobials in Sepsis: A Review. Clin Pharmacokinet 2022; 61:593-617. [PMID: 35218003 PMCID: PMC9095522 DOI: 10.1007/s40262-021-01102-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 02/07/2023]
Abstract
The pathophysiology of sepsis alters drug pharmacokinetics, resulting in inadequate drug exposure and target-site concentration. Suboptimal exposure leads to treatment failure and the development of antimicrobial resistance. Therefore, we seek to optimize antimicrobial therapy in sepsis by selecting the right drug and the correct dosage. A prerequisite for achieving this goal is characterization and understanding of the mechanisms of pharmacokinetic alterations. However, most infections take place not in blood but in different body compartments. Since tissue pharmacokinetic assessment is not feasible in daily practice, we need to tailor antibiotic treatment according to the specific patient’s pathophysiological processes. The complex pathophysiology of sepsis and the ineffectiveness of current targeted therapies suggest that treatments guided by biomarkers predicting target-site concentration could provide a new therapeutic strategy. Inflammation, endothelial and coagulation activation markers, and blood flow parameters might be indicators of impaired tissue distribution. Moreover, hepatic and renal dysfunction biomarkers can predict not only drug metabolism and clearance but also drug distribution. Identification of the right biomarkers can direct drug dosing and provide timely feedback on its effectiveness. Therefore, this might decrease antibiotic resistance and the mortality of critically ill patients. This article fills the literature gap by characterizing patient biomarkers that might be used to predict unbound plasma-to-tissue drug distribution in critically ill patients. Although all biomarkers must be clinically evaluated with the ultimate goal of combining them in a clinically feasible scoring system, we support the concept that the appropriate biomarkers could be used to direct targeted antibiotic dosing.
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Seçilmiş Y, Sağiroğlu P, Doğan AB, Gümüştekin S, Öztürk MA. The Diagnostic Value of Presepsin in Acute Appendicitis and Reference Ranges for Healthy Children. J Trop Pediatr 2022; 68:6511399. [PMID: 35043966 DOI: 10.1093/tropej/fmac001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study aimed to investigate the diagnostic value of presepsin, a new inflammatory marker for paediatric appendicitis, and to determine a reference range of presepsin for children. METHODS This single-center prospective study was conducted in our paediatric emergency department between 1 February 2021 and 1 July 2021. Patients aged 0-18 years diagnosed with acute appendicitis, which was pathologically confirmed, and healthy volunteers in the same age group were included in the study. Serum presepsin levels were analysed using an enzyme-linked immunosorbent assay reader. In addition to presepsin, other acute-phase reactants, paediatric appendicitis scores and imaging methods were evaluated. RESULTS There were 94 patients in the acute appendicitis group and 102 healthy volunteers in the control group. Median values were compared between the two groups, and no statistically significant differences were found (p = 0.544). In addition, no statistically signivficant differences in presepsin levels were found between the acute and perforated appendicitis groups (p = 0.344). The median (IQ1-IQ3) reference range for presepsin in healthy children was 0.9950 (0.7575-1.610) ng/mL. CONCLUSION Presepsin is not a suitable marker for the diagnosis of acute appendicitis. We observed that serum presepsin levels were not elevated in paediatric appendicitis, which is a local infection, in contrast to previous studies.
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Affiliation(s)
- Yilmaz Seçilmiş
- Department of Pediatrics, Division of Pediatric Emergency, Erciyes University, Faculty of Medicine, Kayseri 38039, Turkey
| | - Pinar Sağiroğlu
- Department of Microbiology, Erciyes University, Faculty of Medicine, Kayseri 38039, Turkey
| | - Ahmet Burak Doğan
- Department of Pediatric Surgery, Erciyes University, Faculty of Medicine, Kayseri 38039, Turkey
| | - Seda Gümüştekin
- Department of Pediatrics, Division of Pediatric Emergency, Erciyes University, Faculty of Medicine, Kayseri 38039, Turkey
| | - Mehmet Adnan Öztürk
- Department of Pediatrics, Division of Pediatric Emergency, Erciyes University, Faculty of Medicine, Kayseri 38039, Turkey
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Lee S, Song J, Park DW, Seok H, Ahn S, Kim J, Park J, Cho HJ, Moon S. Diagnostic and prognostic value of presepsin and procalcitonin in non-infectious organ failure, sepsis, and septic shock: a prospective observational study according to the Sepsis-3 definitions. BMC Infect Dis 2022; 22:8. [PMID: 34983420 PMCID: PMC8725484 DOI: 10.1186/s12879-021-07012-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/23/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND We investigated the diagnostic and prognostic value of presepsin among patients with organ failure, including sepsis, in accordance with the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). METHODS This prospective observational study included 420 patients divided into three groups: non-infectious organ failure (n = 142), sepsis (n = 141), and septic shock (n = 137). Optimal cut-off values of presepsin to discriminate between the three groups were evaluated using receiver operating characteristic curve analysis. We determined the optimal cut-off value of presepsin levels to predict mortality associated with sepsis and performed Kaplan-Meier survival curve analysis according to the cut-off value. Cox proportional hazards model was performed to determine the risk factors for 30-day mortality. RESULTS Presepsin levels were significantly higher in sepsis than in non-infectious organ failure cases (p < 0.001) and significantly higher in patients with septic shock than in those with sepsis (p = 0.002). The optimal cut-off value of the presepsin level to discriminate between sepsis and non-infectious organ failure was 582 pg/mL (p < 0.001) and between sepsis and septic shock was 1285 pg/mL (p < 0.001). The optimal cut-off value of the presepsin level for predicting the 30-day mortality was 821 pg/mL (p = 0.005) for patients with sepsis. Patients with higher presepsin levels (≥ 821 pg/mL) had significantly higher mortality rates than those with lower presepsin levels (< 821 pg/mL) (log-rank test; p = 0.004). In the multivariate Cox proportional hazards model, presepsin could predict the 30-day mortality in sepsis cases (hazard ratio, 1.003; 95% confidence interval 1.001-1.005; p = 0.042). CONCLUSIONS Presepsin levels could effectively differentiate sepsis from non-infectious organ failure and could help clinicians identify patients with sepsis with poor prognosis. Presepsin was an independent risk factor for 30-day mortality among patients with sepsis and septic shock.
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Affiliation(s)
- Sukyo Lee
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Juhyun Song
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea.
| | - Dae Won Park
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Hyeri Seok
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Sejoong Ahn
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Jooyeong Kim
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Jonghak Park
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Han-Jin Cho
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Sungwoo Moon
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
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Xiao H, Wang G, Wang Y, Tan Z, Sun X, Zhou J, Duan M, Zhi D, Tang Z, Hang C, Zhang G, Li Y, Wu C, Li F, Zhang H, Wang J, Zhang Y, Zhang X, Guo W, Qi W, Xie M, Li C. Potential Value of Presepsin Guidance in Shortening Antibiotic Therapy in Septic Patients: a Multicenter, Prospective Cohort Trial. Shock 2022; 57:63-71. [PMID: 34618727 DOI: 10.1097/shk.0000000000001870] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
INTRODUCTION Long-term use of antibiotics for septic patients leads to bacterial resistance, increased mortality, and hospital stay. In this study, we investigated an emerging biomarker presepsin-guided strategy, which can be used to evaluate the shortening of antibiotic treatment in patients with sepsis without risking a worse outcome. METHODS In this multicenter prospective cohort trial, patients were assigned to the presepsin or control groups. In the presepsin group, antibiotics were ceased based on predefined cut-off ranges of presepsin concentrations. The control group stopped antibiotics according to international guidelines. The primary endpoints were the number of days without antibiotics within 28 days and mortality at 28 and 90 days. Secondary endpoints were the percentage of patients with a recurrent infection, length of stay in ICU and hospital, hospitalization costs, days of first episode of antibiotic treatment, percentage of antibiotic administration and multidrug-resistant bacteria, and SOFA score. RESULTS Overall, 656 out of an initial 708 patients were eligible and assigned to the presepsin group (n = 327) or the control group (n = 329). Patients in the presepsin group had significantly more days without antibiotics than those in the control group (14.54 days [SD 9.01] vs. 11.01 days [SD 7.73]; P < 0.001). Mortality in the presepsin group showed no difference to that in the control group at days 28 (17.7% vs. 18.2%; P = 0.868) and 90 (19.9% vs. 19.5%; P = 0.891). Patients in the presepsin group had a significantly shorter mean length of stay in the hospital and lower hospitalization costs than control subjects. There were no differences in the rate of recurrent infection and multidrug-resistant bacteria and the SOFA score tendency between the two groups. CONCLUSIONS Presepsin guidance has potential to shorten the duration of antibiotic treatment in patients with sepsis without risking worse outcomes of death, recurrent infection, and aggravation of organ failure. TRIAL REGISTRATION ChiCTR, ChiCTR1900024391. Registered 9 July 2019-Retrospectively registered, http://www.chictr.org.cn.
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Affiliation(s)
- Hongli Xiao
- EICU of Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Guoxing Wang
- EICU of Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yan Wang
- EICU of Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhimin Tan
- EICU of Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xuelian Sun
- EICU of Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jie Zhou
- EICU of Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Deyuan Zhi
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ziren Tang
- EICU of Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Chenchen Hang
- EICU of Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Guoqiang Zhang
- EICU of Department of Emergency Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yan Li
- EICU of Department of Emergency Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Caijun Wu
- EICU of Department of Emergency Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Fengjie Li
- EICU of Department of Emergency Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Haiyan Zhang
- EICU of Department of Emergency Medicine, The Hospital of Shunyi District Beijing, China Medical University, Beijing, China
| | - Jing Wang
- EICU of Department of Emergency Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yun Zhang
- EICU of Department of Emergency Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xinchao Zhang
- EICU of Department of Emergency Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Guo
- EICU of Department of Emergency Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenjie Qi
- Department of Infectious Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Miaorong Xie
- EICU of Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chunsheng Li
- EICU of Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Plasma Soluble CD14 Subtype Levels Are Associated With Clinical Outcomes in Critically Ill Subjects With Coronavirus Disease 2019. Crit Care Explor 2021; 3:e0591. [PMID: 34909698 PMCID: PMC8663850 DOI: 10.1097/cce.0000000000000591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE In bacterial sepsis, CD14 and its N-terminal fragment (soluble CD14 subtype, "Presepsin") have been characterized as markers of innate immune responses and emerging evidence has linked both to coronavirus disease 2019 pathophysiology. OBJECTIVES Our aim was to determine the relationship between the soluble form of CD14 and soluble CD14 subtype plasma levels, coronavirus disease 2019 status, and coronavirus disease 2019-related outcomes. DESIGN A prospective cohort study. SETTING ICUs in three tertiary hospitals in Seattle, WA. PARTICIPANTS Two-hundred four critically ill patients under investigation for coronavirus disease 2019. MAIN OUTCOMES AND MEASURES We measured plasma soluble CD14 and soluble CD14 subtype levels in samples collected upon admission. We tested for associations between biomarker levels and coronavirus disease 2019 status. We stratified by coronavirus disease 2019 status and tested for associations between biomarker levels and outcomes. RESULTS Among 204 patients, 102 patients had coronavirus disease 2019 and 102 patients did not. In both groups, the most common ICU admission diagnosis was respiratory failure or pneumonia and proportions receiving respiratory support at admission were similar. In regression analyses adjusting for age, sex, race/ethnicity, steroid therapy, comorbidities, and severity of illness, soluble CD14 subtype was 54% lower in coronavirus disease 2019 than noncoronavirus disease 2019 patients (fold difference, 0.46; 95% CI, 0.28-0.77; p = 0.003). In contrast to soluble CD14 subtype, soluble CD14 levels did not differ between coronavirus disease 2019 and noncoronavirus disease 2019 patients. In both coronavirus disease 2019 and noncoronavirus disease 2019, in analyses adjusting for age, sex, race/ethnicity, steroid therapy, and comorbidities, higher soluble CD14 subtype levels were associated with death (coronavirus disease 2019: adjusted relative risk, 1.21; 95% CI, 1.06-1.39; p = 0.006 and noncoronavirus disease 2019: adjusted relative risk, 1.19; 95% CI, 1.03-1.38; p = 0.017), shock, and fewer ventilator-free days. In coronavirus disease 2019 only, an increase in soluble CD14 subtype was associated with severe acute kidney injury (adjusted relative risk, 1.23; 95% CI, 1.05-1.44; p = 0.013). CONCLUSIONS Higher plasma soluble CD14 subtype is associated with worse clinical outcomes in critically ill patients irrespective of coronavirus disease 2019 status though soluble CD14 subtype levels were lower in coronavirus disease 2019 patients than noncoronavirus disease 2019 patients. Soluble CD14 subtype levels may have prognostic utility in coronavirus disease 2019.
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