Nakamura Yoshihiko, Ishikura Hiroyasu, Nishida Takeshi, Kawano Yasumasa, Yuge Rie, Ichiki Reiko, Murai Akira
Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180 Japan.
BMC Anesthesiol. 2014 Oct 4;14:88. doi: 10.1186/1471-2253-14-88. eCollection 2014.
Presepsin is useful for differentiating sepsis from non-infection related systemic inflammatory response syndrome. However, there are no studies investigating the usefulness of presepsin in diagnosing sepsis involving patients with acute kidney injury (AKI). The purpose of this study is to determine levels of blood presepsin in patients with or without sepsis and among non-AKI patients or patients with different degrees of AKI severity.
This is a single center retrospective study. 247 patients admitted to the ICU between June 2010 and October 2012 were analyzed for their presepsin levels. We classified the patients into non-AKI and AKI according to the RIFLE (Risk, Injury, Failure, and Loss of kidney function and End-stage kidney disease or simply Loss and ESKD) criteria. We then sub-classified the patients in each group into either non-sepsis or sepsis sub-group and analyzed the accuracy of diagnosing sepsis based on their levels of presepsin.
The number of patients for each group was: non-AKI, 112; under AKI: Risk, 50; Injury, 36; Failure, 42; Loss and ESKD, 7. The levels of presepsin in sepsis groups were significantly higher than that in the non-sepsis group among the non-AKI, Risk and Injury patients (p < 0.0001, p < 0.01, p < 0.01, respectively). However, no significant difference in the level of presepsin between non-sepsis and sepsis groups among patients with Failure. In the receiver operating characteristic (ROC) analysis, the area under the curve (AUC) was 0.784 in the non-AKI group and 0.698 in the AKI comprising Risk, Injury and Failure groups. AUC value for non-AKI was not significantly different from that of AKI (p = 0.200). When 670 pg/mL was used as the cutoff value for presepsin, sensitivity and specificity were 70.3% and 81.3%, respectively. When 864 pg/mL was used as the cutoff value for presepsin, sensitivity and specificity were 71.4% and 63.8%, respectively.
Presepsin level can be a reliable indicator of sepsis not only among non-AKI patients but also patients with less severe forms of AKI. However, it may not be a reliable indicator of sepsis in patients with a more advanced form of AKI.
可溶性髓系细胞触发受体-1（Presepsin）有助于鉴别脓毒症与非感染性全身炎症反应综合征。然而，尚无研究探讨Presepsin在诊断合并急性肾损伤（AKI）患者的脓毒症中的作用。本研究旨在测定脓毒症患者与非脓毒症患者以及非AKI患者或不同程度AKI严重程度患者的血液Presepsin水平。
这是一项单中心回顾性研究。分析了2010年6月至2012年10月间入住重症监护病房（ICU）的247例患者的Presepsin水平。根据RIFLE（肾功能风险、损伤、衰竭、丧失及终末期肾病，或简称为丧失和ESKD）标准将患者分为非AKI组和AKI组。然后将每组患者再分为非脓毒症亚组或脓毒症亚组，并根据其Presepsin水平分析诊断脓毒症的准确性。
每组患者数量分别为：非AKI组112例；AKI组中：风险期50例、损伤期36例、衰竭期42例、丧失期和终末期肾病期7例。在非AKI、风险期和损伤期患者中，脓毒症组的Presepsin水平显著高于非脓毒症组（分别为p＜0.0001、p＜0.01、p＜0.01）。然而，衰竭期患者中，非脓毒症组与脓毒症组的Presepsin水平无显著差异。在受试者工作特征（ROC）分析中，非AKI组曲线下面积（AUC）为0.784，包括风险期、损伤期和衰竭期的AKI组为0.698。非AKI组的AUC值与AKI组无显著差异（p = 0.200）。以Presepsin 670 pg/mL为临界值时，敏感性和特异性分别为70.3%和81.3%。以Presepsin 864 pg/mL为临界值时，敏感性和特异性分别为71.4%和63.8%。
Presepsin水平不仅可以作为非AKI患者脓毒症的可靠指标，也可以作为轻度AKI患者脓毒症的可靠指标。然而，对于晚期AKI患者，它可能不是脓毒症的可靠指标。
