Sepsis biomarkers in unselected patients on admission to intensive or high-dependency care.
Crit Care. 2013 Mar 26;17(2):R60
Authors: Llewelyn MJ, Berger M, Gregory M, Ramaiah R, Taylor AL, Curdt I, Lajaunias F, Graf R, Blincko SJ, Drage S, Cohen J
INTRODUCTION: Although many sepsis biomarkers have shown promise in selected patient groups, only C-reactive protein and procalcitonin (PCT) have entered clinical practice. The aim of this study was to evaluate three promising novel sepsis biomarkers in unselected patients at admission to intensive care. We assessed the performance of pancreatic stone protein (PSP), soluble CD25 (sCD25) and heparin binding protein (HBP), in distinguishing patients with sepsis from those with a non-infective systemic inflammatory response and the ability of these markers to indicate severity of illness. METHODS: Plasma levels of the biomarkers, PCT and selected inflammatory cytokines were measured in samples taken from 219 patients during the first 6 hours of admission to intensive or high dependency care. Patients with a systemic inflammatory response were categorized as having sepsis or a non-infective aetiology, with or without markers of severity, using standard diagnostic criteria. RESULTS: Both PSP and sCD25 performed well as biomarkers of sepsis irrespective of severity of illness. For both markers the area under the receiver operating curve (AUC) was greater than 0.9; PSP 0.927 (0.887-0.968) and sCD25 0.902 (0.854 - 0.949). Procalcitonin and IL6 also performed well as markers of sepsis whilst in this intensive care unit (ICU) population, HBP did not; PCT 0.840 (0.778 - 0.901), IL6 0.805 (0.739 - 0.870) and HBP 0.607 (0.519-0.694). Levels of both PSP and PCT reflected severity of illness and both markers performed well in differentiating patients with severe sepsis from severely ill patients with a non-infective systemic inflammatory response; AUCs 0.955 (0.909-1) and 0.837 (0.732-0.941) respectively. Although levels of sCD25 did not correlate with severity, addition of sCD25 to either PCT or PSP in a multivariate model improved the diagnostic accuracy of either marker alone. CONCLUSIONS: PSP and sCD25 perform well as sepsis biomarkers in patients with suspected sepsis at the time of admission to intensive or high dependency care. These markers warrant further assessment of their prognostic value. Whereas previously published data indicate HBP has clinical utility in the emergency department, it did not perform well in an intensive-care population.
PMID: 23531337 [PubMed - as supplied by publisher]