Abstract
IntroductionSepsis, a leading cause of death in critically ill patients, is the result of complex interactions between the infecting microorganisms and the host responses that influence clinical outcomes. We evaluated the prognostic value of presepsin (sCD14-ST), a novel biomarker of bacterial infection, and compared it with procalcitonin (PCT).MethodsThis is a retrospective, case–control study of a multicenter, randomized clinical trial enrolling patients with severe sepsis or septic shock in ICUs in Italy. We selected 50 survivors and 50 non-survivors at ICU discharge, matched for age, sex and time from sepsis diagnosis to enrollment. Plasma samples were collected 1, 2 and 7 days after enrollment to assay presepsin and PCT. Outcome was assessed 28 and 90 days after enrollment.ResultsEarly presepsin (day 1) was higher in decedents (2,269 pg/ml, median (Q1 to Q3), 1,171 to 4,300 pg/ml) than in survivors (1,184 pg/ml (median, 875 to 2,113); P = 0.002), whereas PCT was not different (18.5 μg/L (median 3.4 to 45.2) and 10.8 μg/L (2.7 to 41.9); P = 0.31). The evolution of presepsin levels over time was significantly different in survivors compared to decedents (P for time-survival interaction = 0.03), whereas PCT decreased similarly in the two groups (P = 0.13). Presepsin was the only variable independently associated with ICU and 28-day mortality in Cox models adjusted for clinical characteristics. It showed better prognostic accuracy than PCT in the range of Sequential Organ Failure Assessment score (area under the curve (AUC) from 0.64 to 0.75 vs. AUC 0.53 to 0.65).ConclusionsIn this multicenter clinical trial, we provide the first evidence that presepsin measurements may have useful prognostic information for patients with severe sepsis or septic shock. These preliminary findings suggest that presepsin may be of clinical importance for early risk stratification.
Highlights
Sepsis, a leading cause of death in critically ill patients, is the result of complex interactions between the infecting microorganisms and the host responses that influence clinical outcomes
The cohorts were matched for age, sex, source center and time of enrollment after confirmation of the inclusion criteria, which were at least one focus of infection, two or more signs of systemic inflammatory reaction syndrome and at least one severe, acute sepsis-related organ dysfunction assessed on the basis of the Sequential Organ Failure Assessment (SOFA) score [10]
Higher levels of presepsin were significantly associated with worse SOFA scores and reduced diuresis
Summary
A leading cause of death in critically ill patients, is the result of complex interactions between the infecting microorganisms and the host responses that influence clinical outcomes. Sepsis is the leading cause of death in critically ill patients and requires early goal-directed management to reduce its high burden of mortality and morbidity [1]. Presepsin (sCD14-ST) is a soluble N-terminal fragment of the cluster of differentiation (CD) marker protein CD14, which is released into the circulation during monocyte activation upon the recognition of lipopolysaccharide (LPS) from infectious agents [6]. It shows promise for diagnostic purposes [7] and powerful prognostic information in septic patients as early as the time of admission [8]. We set out to examine the relationships between early plasma presepsin concentration and mortality in patients with severe sepsis and septic shock and compare its prognostic performance with that of procalcitonin (PCT)
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