Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
Clin Chim Acta. 2019 Mar;490:200-206. doi: 10.1016/j.cca.2018.09.013. Epub 2018 Sep 8.
Levels of the biomarkers presepsin and procalcitonin are affected by renal function. We evaluated the accuracies of presepsin and procalcitonin levels for diagnosing sepsis in patients with and without acute kidney injury (AKI).
We evaluated patients with presepsin and procalcitonin data, and classified them into AKI and non-AKI groups based on the Kidney Disease Improving Global Outcomes criteria. Each group was then subdivided according to sepsis status for each stage of AKI. Receiver operating characteristic curve analyses were used to investigate the accuracies of biomarker levels for diagnosing sepsis.
In the non-AKI group, the area under the curves (AUCs) for procalcitonin and presepsin levels were 0.897 and 0.880, respectively (p = .525) and optimal cut-off values were 0.10 ng/ml (sensitivity: 85.1%, specificity: 79.1%) and 240 pg/ml (sensitivity: 80.9%, specificity: 83.2%), respectively. In the stage 3 subgroup, the AUC for procalcitonin (0.946) was significantly higher than that for presepsin (0.768, p < .001). The optimal cut-off values for diagnosing sepsis were 4.07 ng/ml (sensitivity: 87.2%, specificity: 93.5%) for procalcitonin and 500 pg/ml (sensitivity: 89.7%, specificity: 59.7%) for presepsin.
In patients with severe AKI, the accuracy of the diagnosis of sepsis with procalcitonin was significantly higher than with presepsin.
生物标志物降钙素原和前降钙素的水平受肾功能的影响。我们评估了前降钙素和降钙素原水平在伴有和不伴有急性肾损伤（AKI）的脓毒症患者中的诊断准确性。
我们评估了具有前降钙素和降钙素原数据的患者，并根据肾脏病改善全球结局标准将他们分为 AKI 组和非 AKI 组。然后，根据 AKI 的每个阶段将每组根据脓毒症的状态进一步细分。使用受试者工作特征曲线分析来研究生物标志物水平诊断脓毒症的准确性。
在非 AKI 组中，降钙素原和前降钙素水平的曲线下面积（AUC）分别为 0.897 和 0.880（p=0.525），最佳截断值分别为 0.10ng/ml（敏感性：85.1%，特异性：79.1%）和 240pg/ml（敏感性：80.9%，特异性：83.2%）。在 3 期亚组中，降钙素原的 AUC（0.946）明显高于前降钙素的 AUC（0.768，p<0.001）。诊断脓毒症的最佳截断值分别为降钙素原 4.07ng/ml（敏感性：87.2%，特异性：93.5%）和前降钙素 500pg/ml（敏感性：89.7%，特异性：59.7%）。
在严重 AKI 患者中，降钙素原诊断脓毒症的准确性明显高于前降钙素。
