Clinical value of serum endocan and procalcitonin in early diagnosis and prognosis evaluation of sepsis

Abstract

To investigate the clinical value of serum endocan and procalcitonin (PCT) in early diagnosis and prognosis evaluation of sepsis. The patients with systemic inflammatory response syndrome (SIRS, n = 26) and sepsis (n = 78) admitted to intensive care unit (ICU) of the Third Hospital of Hebei Medical University from December 2014 to December 2016 were enrolled. According to the severity of disease, the sepsis patients were divided into general sepsis group (n = 20), severe sepsis group (n = 24), and septic shock group (n = 34). The cases were divided into survival group (n = 55) and non-survival group (n = 23) according to 28-day mortality. The serum endocan, PCT, acute physiology and chronic health evaluation II (APACHEII) score, and sequential organ failure assessment (SOFA) score were recorded when the patients were admitted into ICU. The differences in endocan, PCT, APACHEII, SOFA score between SIRS and sepsis groups and within sepsis subgroups were compared. Spearman correlation analysis was used to analyze the correlation between the indexes of sepsis patients. Receiver operation characteristic curve (ROC) was used to evaluate the value of endocan and PCT for the diagnosis and prognosis of sepsis. (1) Serum endocan, PCT, APACHEII, SOFA score and 28-day mortality in the sepsis group were significantly higher than those in the SIRS group [endocan (μg/L): 4.28 (10.64) vs. 1.03 (0.69), PCT (μg/L): 3.94 (10.75) vs. 0.43 (0.39), APACHEII: 18.81±9.17 vs. 9.35±3.78, SOFA: 9.00 (7.20) vs. 4.50 (1.50), 28-day mortality: 29.49% vs. 11.54%, all P < 0.01]. The area under the ROC curve (AUC) of endocan, PCT, APACHEII, SOFA score for sepsis diagnosis were 0.887, 0.842, 0.822, 0.835, respectively. When the cut-off value of endocan was 1.26 μg/L, the sepsis diagnostic sensitivity was 87.2% and specificity was 81.8%. When the cut-off value of PCT was 0.75 μg/L, the sepsis diagnostic sensitivity was 85.9% and specificity was 81.8%. (2) With the severity of the disease increased, the index showed an increasing trend in patients with sepsis. Serum endocan, PCT, APACHEII, SOFA score and 28-day mortality in septic shock group were significantly higher than those in severe sepsis group or general sepsis group [endocan (μg/L): 13.02 (6.70) vs. 3.33 (3.05), 1.60 (0.98); PCT (μg/L): 8.10 (17.68) vs. 5.47 (8.92), 1.57 (2.78); APACHEII: 25.00 (9.50) vs. 18.00 (9.00), 9.50 (5.75); SOFA: 13.00 (4.50) vs. 8.00 (3.00), 5.00 (3.50); 28-day mortality: 52.94% vs. 20.83%, 0%; all P < 0.01]. There was a significantly positive correlation between endocan, PCT, APACHEII, SOFA, indicating that the endocan and PCT can be used to assess the severity of sepsis. (3) Serum endocan, PCT, APACHEII and SOFA score in non-survival group were significantly higher than those in the survival group [endocan (μg/L): 15.05 (9.23) vs. 2.32 (4.81), PCT (μg/L): 18.40 (16.99) vs. 3.10 (6.67), APACHEII: 28.13±7.56 vs. 14.91±6.64, SOFA: 14.70±3.65 vs. 7.38±3.26, all P < 0.01]. The AUC of endocan, PCT, APACHEII, SOFA score for the prediction of non-survival sepsis were 0.915, 0.763, 0.899, 0.930. When the cut-off value of endocan was 4.37 μg/L, the septic death prediction sensitivity was 95.7% and specificity was 70.9%. When the cut-off value of PCT was 7.68 μg/L, the septic death prediction sensitivity was 65.2% and specificity was 78.2%. Serum endocan is more clinically valuable than PCT in early diagnosis and prognosis assessment of sepsis.