Abstract
ObjectiveWe investigated serum soluble CD163 (sCD163) levels for use in the diagnosis, severity assessment, and prognosis of sepsis in the critical ill patients and compared sCD163 with other infection-related variables.MethodsDuring july 2010 and April 2011, serum was obtained from 102 sepsis patients (days 1, 3, 5, 7, and 10 after admission to an ICU) and 30 systemic inflammatory response syndrome (SIRS) patients with no sepsis diagnosed. Serum levels of sCD163, procalcitonon (PCT), and C reactive protein (CRP) were determined respectively. Sequential organ failure assessment (SOFA) scores for sepsis patients were also recorded. Then evaluated their roles in sepsis.ResultsThe sCD163 levels were 0.88(0.78–1.00)ug/mL for SIRS patients, 1.50(0.92–2.00)ug/mL for moderate sepsis patients, and 2.95(2.18–5.57)ug/mL for severe sepsis patients on day1. The areas under the ROC curves for sCD163, CRP, and PCT for the diagnosis of sepsis were, respectively, 0.856(95%CI: 0.791–0.921), 0.696(95%CI: 0.595–0.797), and 0.629(95%CI: 0.495–0.763), At the recommended cut-off 1.49 ug/mL for sCD163, the sensitivity is 74.0% with 93.3% specificity. Based on 28-day survivals, sCD163 levels in the surviving group stay constant, while they tended to gradually increase in the non-surviving group.The area under the ROC curve for sCD163 for sepsis prognosis was 0.706(95%CI 0.558–0.804). Levels of sCD163 with cut-off point >2.84 ug/mL have sensitivity of 55.8.0%, specificity 80.4%.Common risk factors for death and sCD163 were included in multivariate logistic regression analysis; the odds ratios (OR) for sCD163 and SOFA scores for sepsis prognosis were 1.173 and 1.396, respectively (P<0.05). Spearman rank correlation analysis showed that sCD163 was weakly, but positively correlated with CRP, PCT, and SOFA scores (0.2< r <0.4, P<0.0001), but not with leukocyte counts (r <0.2, P = 0.450).ConclusionSerum sCD163 is superior to PCT and CRP for the diagnosis of sepsis and differentiate the severity of sepsis. sCD163 levels were more sensitive for dynamic evaluations of sepsis prognosis. Serum sCD163 and SOFA scores are prognostic factors for sepsis.Trial Registration www.chictr.org ChiCTR-ONC-10000812
Highlights
Sepsis is a systemic inflammatory disease that has a high incidence and mortality and requires high utilization rates of health care resources [1]
We investigated the use of soluble CD163 (sCD163) levels for the early diagnosis of sepsis and its prognosis for patients admitted to an ICU
Logistic Regression Analysis The initial values for sCD163, C reactive protein (CRP), and PCT levels, WBCs, Sequential organ failure assessment (SOFA) scores, age, gender, and co-morbidities were included in a multivariable logistic regression analysis. These results showed that sCD163 levels and SOFA scores were factors associated with disease prognosis with respective odd ratios of 1.173 and 1.396 (P,0.05; Table 5)
Summary
Sepsis is a systemic inflammatory disease that has a high incidence and mortality and requires high utilization rates of health care resources [1]. It is the second leading cause of death in the ICU after cardiac disease [2]. An epidemiological study conducted in Europe showed that sepsis was promptly confirmed in only 37% of patients and that pathogens were identified in only 38.6% of these patients [5]. Some variables, such as leukocyte counts, C reactive protein (CRP), and procalcitonin (PCT), have been applied to the diagnosis of sepsis and to determine its severity, recent evidence has highlighted the need for variables with high sensitivity and specificity that can be used to dynamically evaluate sepsis severity and prognosis
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