Abstract
IntroductionSepsis, severe sepsis and septic shock are common conditions with high mortality. Their early diagnosis in the Emergency Department (ED) is one of the keys to improving 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 (sCD14) or presepsin is the free fragment of a glycoprotein expressed on monocytes and macrophages. Preliminary reports suggest that levels of presepsin are significantly higher in septic patients than in 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 and suspected sepsis or septic shock.MethodsThis study was conducted in two major hospitals in Turin, Italy. One hundred six patients presenting to the EDs with suspected sepsis or septic shock were included, and another eighty-three patients affected by SIRS, but with no clinical evidence of infection, were recruited as controls. Blood samples were collected at first medical evaluation and for some patients after 24 and 72 h. The samples were analyzed using the PATHFAST Presepsin assay for sCD14, and commercial kits were used for other determinations (for example, PCT). Definitive diagnosis and survival rates were obtained afterward by analysis of digital medical records.ResultsElevated 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). The diagnostic accuracy of PCT was generally higher, and areas under the curve (AUCs) were 0.875 for PCT and 0.701 for presepsin. Mean presepsin values were significantly higher in nonsurvivor septic patients (60-day mortality) than in survivors. No significant correlation was noted between PCT and survival.ConclusionsIn our experience, presepsin was useful in the early diagnosis of infection in a complex population of patients with SIRS, sepsis, severe sepsis and septic shock who presented 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.
Highlights
Sepsis, severe sepsis and septic shock are common conditions with high mortality
In our experience, presepsin was useful in the early diagnosis of infection in a complex population of patients with systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis and septic shock who presented to the Emergency Department (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
Summary
Severe sepsis and septic shock are common conditions with high mortality Their early diagnosis in the Emergency Department (ED) is one of the keys to improving survival. Severe sepsis and septic shock are some of the most common conditions handled in the Emergency Department (ED) and ICU, and, despite modern antibiotic therapy in conjunction with cardiovascular and respiratory support, mortality rates remain between 30% and 60% [1,2,3]. PCT has an established role as a biomarker in septic patients and has been shown to correlate closely with infection, it has some limitations It rises transiently in patients with nonseptic conditions and systemic inflammatory response syndromes (SIRS) (for example, trauma, surgery, heatstroke) and is not detectable in certain cases of sepsis. The ideal biomarker should retain high sensitivity and specificity and be cost-effective and promptly available
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