Diagnóstico y pronóstico de sepsis con presepsina en el Departamento de Urgencias

Abstract

IntroductionSoluble presepsin (PSEP) a subtype of CD14 or sCD14-ST is a complex product of CD14 cleavage that is released into the general circulation and can now be quantified by a rapid automated method. The circulating levels of PSEP can be perceived as a control of activated monocytes-macrophages in response to pathogens. Thus, PSEP represents a biomarker of the initial phase of the systemic infection. The objective of the study is to evaluate the diagnostic and prognostic value of PSEP in subjects with sepsis and septic shock in an emergency department. Materials and methodsPilot, observational, prospective study was conducted on 50 subjects who fulfilled the selection criteria, and admitted to the Emergency Department during the period July 2016 to January 2017. The demographic variables, diagnosis of sepsis or septic shock, and mortality were collected. Biomarker analyses were performed, and compared for the early diagnosis of infection, such as: presepsin (PSEP), procalcitonin, C-reactive protein, on admission, at 48hours, and on the seventh day. NT-proBNP was performed at hour 0. ResultsThe mean age of the subjects in the study was 69.8 years (SD ± 15,6), and 46% of the participants were men. The subjects were stratified into 3groups: chronic kidney disease (CKD) with sepsis/shock (n = 14), sepsis (n = 21), and septic shock (n = 15). When comparing the means of the quantitative variables, and depending on which of the 3observation groups they belonged, it was found that the PSEP value at zero hour was significantly different (P<.05), being notable in the participants with kidney disease, and in those with septic shock. Similarly, it was found that the value of NT-proBNP at hour 0, and the Sepsis-related organ failure assessment (SOFA) score at zero hour, and at 48hours had significant differences (P<.05). Statistical analysisThe analysis of the information was performed using measurement of central tendency and dispersion. The cut-off points established for sepsis, septic shock, and patients with CKD were applied to the sample in the contingency table to evaluate the diagnostic test, its sensitivity, specificity, PPV and NPV, and ROC curve. CommentPSEP demonstrated its diagnostic and prognostic value in sepsis in this pilot study. A national Multicentre study will be used to validate the test in Colombia and demonstrate its diagnostic efficacy.