Liu Bo, Chen Yun-Xia, Yin Qin, Zhao Yun-Zhou, Li Chun-Sheng
Crit Care. 2013 Oct 20;17(5):R244. doi: 10.1186/cc13070.
Presepsin levels are known to be increased in sepsis. The aim of this study was to evaluate the early diagnostic and prognostic value of Presepsin compared with procalcitonin (PCT), Mortality in Emergency Department Sepsis (MEDS) score and Acute Physiology and Chronic Health Evaluation II (APACHE II) score in septic patients in an emergency department (ED) and to investigate Presepsin as a new biomarker of sepsis.
This study enrolled 859 consecutive patients with at least two diagnostic criteria for systemic inflammatory response syndrome (SIRS) who were admitted to Beijing Chao-yang Hospital ED from December 2011 to October 2012, and 100 age-matched healthy controls. Patients were stratified into four groups: SIRS, sepsis, severe sepsis, and septic shock. Plasma Presepsin and serum PCT were measured, and MEDS score and APACHE II score were calculated at enrollment. Comparisons were analyzed using the Kruskal-Wallis and Mann-Whitney U tests.
On admission, the median levels of plasma Presepsin increased with sepsis severity. The areas under the receiver operating characteristic (AUC) curves of Presepsin were greater than those of PCT in diagnosing sepsis, and predicting severe sepsis and septic shock. The AUC of Presepsin for predicting 28-day mortality in septic patients was slightly lower than that of PCT, MEDS score and APACHE II score. The AUC of a combination of Presepsin and MEDS score or APACHE II score was significantly higher than that of MEDS score or APACHE II score alone in predicting severe sepsis, and was markedly higher than that of Presepsin alone in predicting septic shock and 28-day mortality in septic patients, respectively. Plasma Presepsin levels in septic patients were significantly higher in non-survivors than in survivors at 28 days' follow-up. Presepsin, MEDS score and APACHE II score were found to be independent predictors of severe sepsis, septic shock and 28-day mortality in septic patients. The levels of plasma Presepsin were positively correlated with PCT, MEDS score and APACHE II score in every septic group.
Presepsin is a valuable biomarker for early diagnosis of sepsis, risk stratification, and evaluation of prognosis in septic patients in the ED.
已知脓毒症患者的可溶性髓系细胞触发受体-1（Presepsin）水平会升高。本研究旨在评估Presepsin与降钙素原（PCT）、急诊科脓毒症死亡率（MEDS）评分及急性生理与慢性健康状况评分系统II（APACHE II）评分相比，在急诊科（ED）脓毒症患者中的早期诊断和预后价值，并探究Presepsin作为脓毒症新生物标志物的可能性。
本研究纳入了2011年12月至2012年10月期间连续入住北京朝阳医院急诊科的859例符合至少两条全身炎症反应综合征（SIRS）诊断标准的患者，以及100例年龄匹配的健康对照者。患者被分为四组：SIRS、脓毒症、严重脓毒症和脓毒性休克。在入组时检测血浆Presepsin和血清PCT水平，并计算MEDS评分和APACHE II评分。采用Kruskal-Wallis检验和Mann-Whitney U检验进行比较分析。
入院时，血浆Presepsin的中位数水平随脓毒症严重程度增加而升高。Presepsin在诊断脓毒症、预测严重脓毒症和脓毒性休克方面的受试者工作特征曲线（AUC）下面积大于PCT。Presepsin预测脓毒症患者28天死亡率的AUC略低于PCT、MEDS评分和APACHE II评分。Presepsin与MEDS评分或APACHE II评分联合预测严重脓毒症的AUC显著高于单独的MEDS评分或APACHE II评分，在预测脓毒性休克和脓毒症患者28天死亡率方面分别显著高于单独的Presepsin。在28天随访时，脓毒症患者中非存活者的血浆Presepsin水平显著高于存活者。Presepsin、MEDS评分和APACHE II评分是脓毒症患者严重脓毒症、脓毒性休克和28天死亡率的独立预测因素。在每个脓毒症组中，血浆Presepsin水平与PCT、MEDS评分和APACHE II评分呈正相关。
Presepsin是急诊科脓毒症患者早期诊断、风险分层及预后评估的有价值生物标志物。
