Discriminatory ability and prognostic evaluation of presepsin for sepsis-related acute respiratory distress syndrome

Jiangnan Zhao,Yan Tan,Li Wang,Yi Shi

doi:10.1038/s41598-020-66121-7

Abstract

Sepsis-related acute respiratory distress syndrome (ARDS) has worse clinical outcomes than non-sepsis-related ARDS. Presepsin is known to be elevated in sepsis, but little is known about its discriminatory ability and prognostic evaluation in patients with sepsis-related ARDS. This study was a multicenter prospective cohort study of 225 consecutive ARDS patients. Patients with sepsis-related ARDS had higher presepsin levels than patients with non-sepsis-related ARDS (P < 0.001). The area under the receiver operating characteristic (ROC) curve of presepsin (0.81) was significantly greater than that of PCT (0.62) in diagnosing sepsis-related ARDS (P = 0.001). Among patients with sepsis-related ARDS, presepsin levels were significantly higher in non-survivors than in survivors (P < 0.001). Presepsin was found to be an independent predictor of in-hospital mortality in sepsis-related ARDS. Based on ROC analysis, the addition of presepsin improved discrimination based on SOFA or APACHE II scores from 0.77 to 0.87 or 0.73 to 0.85 (all P < 0.05), respectively. The levels of plasma presepsin were positively correlated with disease severity, as determined by the SOFA score in the sepsis-related ARDS group (P < 0.001). Presepsin is a valuable biomarker for early stratification of sepsis-related ARDS. Higher plasma presepsin levels are associated with increased mortality in sepsis-related ARDS.

Highlights

Sepsis-related acute respiratory distress syndrome (ARDS) has worse clinical outcomes than non-sepsisrelated ARDS
Sepsis as the most commonly encountered cause of ARDS is generally associated with higher mortality than other risk factors[3,17,18,19]
Our study demonstrated that sepsis- and non-sepsis- related ARDS present differently in terms of clinical characteristics, with higher severity of illness and worse clinical outcomes in sepsis-related ARDS

Summary

Introduction

Sepsis-related acute respiratory distress syndrome (ARDS) has worse clinical outcomes than non-sepsisrelated ARDS. Among patients with sepsis-related ARDS, presepsin levels were significantly higher in non-survivors than in survivors (P < 0.001). The levels of plasma presepsin were positively correlated with disease severity, as determined by the SOFA score in the sepsis-related ARDS group (P < 0.001). Higher plasma presepsin levels are associated with increased mortality in sepsis-related ARDS. Previous clinical studies have confirmed that plasma presepsin levels are significantly increased in patients with sepsis, and are positively correlated with the severity of sepsis[7,9,13,14]. No studies have queried whether presepsin differs between relevant subgroups in ARDS (i.e. sepsis and non-sepsis) Based on these premises, we designed a multicenter prospective study to determine whether presepsin levels differed between sepsis-related and non-sepsis-related ARDS and to investigate the clinical value of presepsin in early diagnosis and prognostic evaluation of sepsis-related ARDS

Methods

Results

Conclusion