Sargentini Valeria, Ceccarelli Giancarlo, D'Alessandro Mariadomenica, Collepardo Daniela, Morelli Andrea, D'Egidio Annalia, Mariotti Sabrina, Nicoletti Anna Maria, Evangelista Berta, D'Ettorre Gabriella, Angeloni Antonio, Venditti Mario, Bachetoni Alessandra
Clin Chem Lab Med. 2015 Mar;53(4):567-73. doi: 10.1515/cclm-2014-0119.
Systemic bacterial infection carries a high risk of mortality in critical care patients. Improvements in diagnostic procedures are required for effective management of sepsis. Recently, the soluble CD14 subtype, or presepsin, has been suggested as a reliable marker of sepsis, and we set out to compare its diagnostic performance with that of procalcitonin (PCT). We focused on a cohort of septic patients who, during their hospitalization, relapsed after a period of clinical relief from symptoms.
In total 21 adult patients were studied during their hospitalization in the Critical Care Unit of Policlinico Umberto I hospital; 74 plasma samples were collected at multiple time points, and presepsin levels were measured using a PATHFAST analyzer.
Presepsin and PCT were significantly lower in healthy controls than in sepsis or severe sepsis (p<0.001), both enabled a significant difference to be detected between systemic inflammatory response syndrome (SIRS) and severe sepsis (p<0.05). The area under the curve (AUC) calculated from the receiver operating characteristic (ROC) curve analysis was 0.888 for presepsin and 0.910 for PCT. In those patients in whom a clinical recurrence of sepsis was observed, while PCT levels normalized during the transient remission phase, presepsin levels (>1000 pg/mL) remained high.
This study confirms the importance of monitoring a combination of several biomarkers in order to obtain a reliable diagnosis. Maximal presepsin levels could alert clinicians not to suspend antibiotic treatments and to carefully monitor septic patients' state of health, even after clinical symptoms have disappeared and PCT levels returned to normal.
全身性细菌感染在重症监护患者中具有很高的死亡风险。有效的脓毒症管理需要改进诊断程序。最近，可溶性CD14亚型即可溶性髓系细胞触发受体-1（sCD14）已被认为是脓毒症的可靠标志物，我们着手比较其与降钙素原（PCT）的诊断性能。我们重点关注了一组脓毒症患者，他们在住院期间，在临床症状缓解一段时间后病情复发。
总共21名成年患者在罗马第一大学综合医院重症监护病房住院期间接受研究；在多个时间点采集了74份血浆样本，并使用PATHFAST分析仪测量sCD14水平。
健康对照组的sCD14和PCT水平显著低于脓毒症或严重脓毒症患者（p<0.001），两者均能检测到全身炎症反应综合征（SIRS）和严重脓毒症之间的显著差异（p<0.05）。根据受试者工作特征（ROC）曲线分析计算的曲线下面积（AUC），sCD14为0.888，PCT为0.910。在观察到脓毒症临床复发的患者中，虽然PCT水平在短暂缓解期恢复正常，但sCD14水平（>1000 pg/mL）仍然很高。
本研究证实了监测多种生物标志物组合以获得可靠诊断的重要性。即使临床症状消失且PCT水平恢复正常，sCD14的最高水平仍可提醒临床医生不要暂停抗生素治疗，并仔细监测脓毒症患者的健康状况。
