Utility of presepsin (sCD14-ST) as a diagnostic and prognostic marker of sepsis in the emergency department

Ricardo Carpio,Juan Zapata,Eberhard Spanuth,Georg Hess

doi:10.1016/j.cca.2015.08.013

Abstract

BackgroundPresepsin (PSEP) is released during infectious diseases and can be detected in the blood. PSEP has shown promising results as sepsis marker. We examined the diagnostic and prognostic validity of PSEP in patients suspicious of sepsis on admission in the emergency department (ED). MethodsOne hundred twenty three patients with signs of SIRS and/or sepsis and 123 healthy individuals were enrolled. PSEP was determined on admission, after 8, 24 and 72h. ResultsMean PSEP concentrations of the control group and the patient group were 130 and 1945pg/ml. PSEP differed between SIRS, sepsis, severe sepsis and septic shock and showed strong association with 30-day mortality ranging from 10.3% in the 1st to 32.1% in the 4th quartile. The ROC curve analyses revealed an AUC value of 0.743. Combined assessment of PSEP and MEDS score increased the AUC up to 0.878 demonstrating the close relationship with outcome. Based on the PSEP values in the different severity degrees, decision thresholds for risk stratification were established. The course of PSEP during the first 72h was associated with effectiveness of treatment and outcome. ConclusionsPSEP allowed outcome prediction already on admission to a similar degree as the clinical scores MEDS and APACHE II. Combination of PSEP with MEDS score improved the discriminatory power for outcome prediction.

Highlights

IntroductionThe most commonly used biomarkers are C-reactive protein (CRP) and procalcitonin (PCT), but these markers have failed to be useful for individual prognostic stratification and for identification of those patients with early sepsis who are at high risk of developing severe sepsis or septic shock
Patients with severe infections and presumed sepsis account for a considerable group of patients admitted to an emergency department
The PSEP concentrations measured in EDTA plasma samples obtained from 123 healthy volunteers revealed a PSEP range of 58 to 339 ng/l and a 95% reference interval based on normal distribution according to CLSI C28-A3, with an upper and lower reference limit of 236 ng/l and 24 ng/l

Summary

Introduction

The most commonly used biomarkers are C-reactive protein (CRP) and procalcitonin (PCT), but these markers have failed to be useful for individual prognostic stratification and for identification of those patients with early sepsis who are at high risk of developing severe sepsis or septic shock. We examined the diagnostic and prognostic validity of PSEP in patients suspicious of sepsis on admission in the emergency department (ED). PSEP differed between SIRS, sepsis, severe sepsis and septic shock and showed strong association with 30-day mortality ranging from 10.3 % in the 1st to 32.1% in the 4th quartile. Combined assessment of PSEP and MEDS score increased the AUC up to 0.878 demonstrating the close relationship with outcome. Conclusions: PSEP allowed outcome prediction already on admission to a similar degree as the clinical scores MEDS and APACHE II.

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