García de Guadiana-Romualdo Luis, Berger Mario, Jiménez-Santos Enrique, Rebollo-Acebes Sergio, Jiménez-Sánchez Roberto, Esteban-Torrella Patricia, Hernando-Holgado Ana, Ortín-Freire Alejandro, Albaladejo-Otón María Dolores
Clinical Chemistry Laboratory, Santa Lucía Hospital, Cartagena, Spain.
Philips Handheld Diagnostics, Eindhoven, the Netherlands.
Eur J Clin Invest. 2017 Apr;47(4):297-304. doi: 10.1111/eci.12732. Epub 2017 Mar 10.
Infection is a common problem in emergency departments (EDs) and is associated with high mortality, morbidity and costs. Identifying infection in ED patients can be challenging. Biomarkers can facilitate its diagnosis, enabling an early management and improving outcomes. In the critical care setting, two emerging biomarkers, pancreatic stone protein (PSP) and soluble CD25 (sCD25), have demonstrated to be useful for diagnosis of sepsis. We aimed to assess the diagnostic value of these biomarkers, in comparison with procalcitonin (PCT), for infection and sepsis in an ED population with suspected infection.
Through a prospective, observational study, we investigated the utility of serum PCT, PSP and sCD25 levels, measured on admission, for diagnosis of infection and sepsis, defined according to the recently updated for sepsis (Sepsis-3), in patients presenting to the ED for suspected infection. Diagnostic accuracy was evaluated by using receiver operating characteristic curves (ROC) analysis.
Of the 152 patients enrolled in this study, 129 had a final diagnosis of infection, including 82 with noncomplicated infection and 47 with sepsis. Median PCT, PSP and sCD25 levels were significantly higher in patients with infection and sepsis. The ROC curve analysis revealed a similar diagnostic accuracy for infection (ROC area under the curve (AUC) PCT: 0·904; sCD25: 0·869 and PSP: 0·839) and for sepsis (ROC AUC: PCT: 0·820; sCD25: 0·835 and PSP: 0·872).
Pancreatic stone protein and sCD25 perform well as infection and sepsis biomarkers, with a similar performance than PCT, in ED patients with suspected infection. Further larger studies investigating use of PSP and sCD25 are needed.
感染是急诊科常见问题，与高死亡率、发病率及成本相关。在急诊科患者中识别感染具有挑战性。生物标志物有助于其诊断，可实现早期管理并改善预后。在重症监护环境中，两种新兴生物标志物，即胰石蛋白（PSP）和可溶性CD25（sCD25），已证明对脓毒症诊断有用。我们旨在评估这些生物标志物与降钙素原（PCT）相比，对疑似感染的急诊科患者感染和脓毒症的诊断价值。
通过一项前瞻性观察性研究，我们调查了入院时测定的血清PCT、PSP和sCD25水平对疑似感染而前往急诊科就诊患者感染和脓毒症的诊断效用，感染和脓毒症根据最近更新的脓毒症定义（脓毒症-3）来界定。通过使用受试者工作特征曲线（ROC）分析评估诊断准确性。
本研究纳入的152例患者中，129例最终诊断为感染，其中82例为非复杂性感染，47例为脓毒症。感染和脓毒症患者的PCT、PSP和sCD25水平中位数显著更高。ROC曲线分析显示，对于感染（曲线下面积（AUC）：PCT为0.904；sCD25为0.869；PSP为0.839）和脓毒症（ROC AUC：PCT为0.820；sCD25为0.835；PSP为0.872），诊断准确性相似。
在疑似感染的急诊科患者中，胰石蛋白和sCD25作为感染和脓毒症生物标志物表现良好，与PCT表现相似。需要进一步开展更大规模的研究来调查PSP和sCD25的应用。
