Fujii Emi, Fujino Kazunori, Eguchi Yutaka
Department of Critical and Intensive Care Medicine Shiga University of Medical Science Otsu Shiga Japan.
Acute Med Surg. 2019 Mar 1;6(2):158-164. doi: 10.1002/ams2.397. eCollection 2019 Apr.
Presepsin values could assist early diagnosis and prognosis of sepsis. In sepsis, prognosis is determined according to multiple organ dysfunction, where coagulopathy is common and associated with prognosis. This study aimed to determine the correlation between presepsin value trend and prognosis, and investigate coagulation abnormality in sepsis.
We retrospectively examined 18 intensive care unit patients diagnosed with sepsis whose presepsin values at admission were ≥500 ng/mL. If presepsin values had decreased ≥50% on hospital day 6, compared to admission values, the patient was allocated into a decreased presepsin group.
Presepsin values in non-survivors with sepsis were significantly higher than in survivors on day 6 ( = 0.022). No significant differences in procalcitonin or C-reactive protein were identified between survivors and non-survivors, and platelet counts were significantly lower in non-survivors on days 0, 3, and 6 ( = 0.001, < 0.001, and = 0.001, respectively). The 90-day mortality rate in a decreased presepsin group significantly improved, even when presepsin values were high on admission ( = 0.012). Platelet counts were significantly lower on all hospital days in the non-decreased presepsin group.
Fifty percent decrease in presepsin levels could be a useful prognostic predictor of sepsis. Larger studies are required to confirm our findings.
可溶性髓系细胞触发受体-1（presepsin）值有助于脓毒症的早期诊断和预后评估。在脓毒症中，预后根据多器官功能障碍来判定，其中凝血病很常见且与预后相关。本研究旨在确定presepsin值变化趋势与预后之间的相关性，并调查脓毒症中的凝血异常情况。
我们回顾性研究了18例入住重症监护病房、入院时presepsin值≥500 ng/mL且被诊断为脓毒症的患者。如果在住院第6天时presepsin值较入院时下降≥50%，则将该患者归入presepsin值下降组。
脓毒症非存活者在第6天的presepsin值显著高于存活者（P = 0.022）。存活者与非存活者之间降钙素原或C反应蛋白无显著差异，且非存活者在第0天、第3天和第6天的血小板计数显著更低（分别为P = 0.001、P < 0.001和P = 0.001）。即使入院时presepsin值较高，presepsin值下降组的90天死亡率仍显著改善（P = 0.012）。presepsin值未下降组在所有住院日的血小板计数均显著更低。
presepsin水平下降50%可能是脓毒症有用的预后预测指标。需要更大规模的研究来证实我们的发现。
