Diagnostic and prognostic value of Presepsin in the management of sepsis in the emergency department: a multicentre prospective study.
Crit Care. 2013 Jul 30;17(4):R168
Authors: Ulla M, Pizzolato E, Lucchiari M, Loiacono M, Soardo F, Forno D, Morello F, Lupia E, Moiraghi C, Mengozzi G, Battista S
INTRODUCTION:: Sepsis, severe sepsis and septic shock are frequent conditions with high mortality, their early diagnosis in the emergency department (ED) is one of the keys to improve survival. Procalcitonin (PCT) has been used as a biomarker in septic patients but has limited specificity, and can be elevated in other scenarios of Systemic Inflammatory Response Syndrome (SIRS). Soluble CD14 or Presepsin is the free fragment of a glycoprotein expressed on monocytes/macrophages: preliminary reports suggest that levels of presepsin are significantly higher in septic patients compared to healthy individuals. The aim of this study is to investigate the diagnostic and prognostic value of Presepsin, compared to PCT, in people presenting at the ED with SIRS, suspected sepsis or septic shock.
METHOD: S: The study was conducted in two major hospitals in Turin. 106 patients presenting to the ED with suspected sepsis or septic shock were included, with 83 more patients affected by SIRS, but with no clinical evidence of infection, recruited as controls. Blood samples were collected at first medical evaluation, and for some patients after 24 and 72 hours; the samples were analyzed using the Pathfast(R) Presepsin assay for sCD14 and commercial kits for other determinations (e.g. PCT). Definitive diagnosis and survival rates were afterward obtained by analysis of digital medical records.
RESULTS:: Elevated concentrations of Presepsin at presentation were observed in septic patients compared to control patients; the same trend was observed for mean values of PCT. Higher values of Presepsin were observed in septic patients at presentation (Time 0, T0). Diagnostic accuracy of PCT was generally higher, and Areas Under the Curve (AUCs) were 0.875 for PCT and 0.701 for Presepsin respectively. Mean Presepsin values were significantly higher in non-survivor septic patients (60-day-mortality) than in survivors. No significant correlation was noted between PCT and survival.
CONCLUSIONS:: In our experience, Presepsin was useful in early diagnosis of infection in a complex population of patients with SIRS, sepsis, severe sepsis and septic shock presenting to the ED. Presepsin showed a significant prognostic value and initial values were significantly correlated with in hospital mortality of patients affected by sepsis, severe sepsis or septic shock.
PMID: 23899120 [PubMed - as supplied by publisher]