Abstract
BackgroundEarly diagnostic and prognostic stratification of patients with suspected infection is a difficult clinical challenge. We studied plasma pentraxin 3 (PTX3) upon admission to the emergency department in patients with suspected infection.MethodsThe study comprised 537 emergency room patients with suspected infection: 59 with no systemic inflammatory response syndrome (SIRS) and without bacterial infection (group 1), 67 with bacterial infection without SIRS (group 2), 54 with SIRS without bacterial infection (group 3), 308 with sepsis (SIRS and bacterial infection) without organ failure (group 4) and 49 with severe sepsis (group 5). Plasma PTX3 was measured on admission using a commercial solid-phase enzyme-linked immunosorbent assay (ELISA).ResultsThe median PTX3 levels in groups 1–5 were 2.6 ng/ml, 4.4 ng/ml, 5.0 ng/ml, 6.1 ng/ml and 16.7 ng/ml, respectively (p<0.001). The median PTX3 concentration was higher in severe sepsis patients compared to others (16.7 vs. 4.9 ng/ml, p<0.001) and in non-survivors (day 28 case fatality) compared to survivors (14.1 vs. 5.1 ng/ml, p<0.001). A high PTX3 level predicted the need for ICU stay (p<0.001) and hypotension (p<0.001). AUCROC in the prediction of severe sepsis was 0.73 (95% CI 0.66–0.81, p<0.001) and 0.69 in case fatality (95% CI 0.58–0.79, p<0.001). PTX3 at a cut-off level for 14.1 ng/ml (optimal cut-off value for severe sepsis) showed 63% sensitivity and 80% specificity. At a cut-off level 7.7 ng/ml (optimal cut-off value for case fatality) showed 70% sensitivity and 63% specificity in predicting case fatality on day 28.In multivariate models, high PTX3 remained an independent predictor of severe sepsis and case fatality after adjusting for potential confounders.ConclusionsA high PTX3 level on hospital admission predicts severe sepsis and case fatality in patients with suspected infection.
Highlights
Severe sepsis is a important disease associated with significant mortality [1]
Aim of the present study was to evaluate the usefulness of plasma pentraxin 3 (PTX3) determination in early stratification and in predicting the development of severe sepsis and mortality in a large and unselected cohort of patients with suspected infection admitted to the emergency room
PTX3 values showed a positive correlation with PCT (r = 0.562, p,0.001) and C-reactive protein (CRP) (r = 0.222, p,0.001), WBC (r = 0.236, p,0.001) and creatinine concentration (r = 0.171, p,0.001)
Summary
Severe sepsis is a important disease associated with significant mortality [1]. Diagnosis and stratification of sepsis patients is difficult but essential, because early interventions and appropriate antimicrobial treatment can be life saving [2,3]. Median (range) Gender (female/male) Obesity (BMI$30)a Alcohol abuseb Smoking (current smoker) Diabetes (type 1 and 2) Malignancy (solid or haematological) Rheumatic diseases Chronic renal insufficiencyc Cardiovascular diseased COPD or asthmae Operation six months previously Devicef Continuous medicationg Continuous cortisone treatmenth Blood culturesi Positive (clinically significant) Positive (contamination) Blood cultures taken after antimicrobial treatment has started abody mass index. Diagnostic and prognostic stratification of patients with suspected infection is a difficult clinical challenge.
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