Роль пресепсина в оценке тяжести и эффективности лечения гнойного пиелонефрита

Abstract

to determine the importance of a presepsin plasma level for early identification of urosepsis, assessment the severity and efficiency of therapy. From 2017 to 2018 . a prospective controlled randomized cohort study with 32 patients (6 men, 26 women) aged from 20 to 60 years was conducted. Patients with diagnosed or suspected purulent pyelonephritis were randomized into two groups depending on the treatment strategy. In Group 1, patients received drug therapy, while in Group 2 surgical treatment was performed due to ineffectiveness of drug therapy. In both groups a level of presepsin was assessed and compared with the clinical manifestation of acute pyelonephritis and the choice of adequate treatment. The mean presepsin level in Group 1 at the admission was 338.4 pg/ml (normal value - 97 pg/ml), while in Group 2 it was 501.125 pg/ml. The presepsin level significantly decreased in both groups on Days 6-7 (<0.005), to 120.4 pg/ml and 66.875 pg/ml, respectively. Consequently, according to clinical and laboratory data, acute purulent pyelonephritis in patients who received combined therapy was successfully managed without surgical treatment, which was confirmed by the positive changes in body temperature, pain severity, blood analysis (leucocytes, ESR) and urine (protein, leukocytes) due to timely detection of presepsin level. Our analysis showed that recovery occurred in both groups, but there are differences in the duration of the disease depending on treatment strategy. Using the presepsin level, we found: In Group 1 the level was 338.4 pg/ml (1.5 times less than in Group 2, <0.005), which indicates the possibility of systemic infection. In this group the surgical treatment was avoided without any fatal consequences. In Group 2, in patients who were undergone to surgical treatment the mean baseline presepsin level was 501.125 pg/ml, which indicates the moderate risk of systemic infection (severe sepsis) and increased risk of adverse outcomes, therefore, surgical treatment was recommended. Thus, the determination of presepsin level can influence on the choice of treatment strategy. The analysis of presepsin level is necessary for the choice of treatment strategy, since the clinical and laboratory data does not always reflect the changes in the kidneys.