Department of Medical Technology, Tokushima University Hospital, Tokushima, Japan.
Department of Nephrology, Tokushima University Hospital, Tokushima, Japan.
PLoS One. 2019 Sep 6;14(9):e0215791. doi: 10.1371/journal.pone.0215791. eCollection 2019.
Presepsin, a glycoprotein produced during bacterial phagocytosis, is used as a sepsis marker for bacterial infections. However, presepsin levels are affected by renal function, and the evaluation criteria according to kidney function or in chronic kidney diseases remain controversial. Furthermore, presepsin may be increased by sample stirring, but no studies have evaluated this effect.In this study, we excluded the effect of stirring by standardizing the blood collection conditions, analyzed the influence of kidney function on presepsin concentrations, and recalculated the reference range based on the findings. EDTA-whole blood from 47 healthy subjects and 85 patients with chronic kidney disease was collected to measure presepsin by PATHFAST. Presepsin was found to be significantly correlated with the levels of creatinine (r = 0.834), eGFRcreat (r = 0.837), cystatin-C (r = 0.845), and eGFRcys (r = 0.879). Furthermore, in patients with CKD, presepsin levels stratified by eGFRcys showed a significant increase in the CKD G2 patient group and with advancing glomerular filtration rate stage. The following values were obtained: Normal: 97.6 ± 27.4 pg/mL, CKD G1: 100.2 ± 27.6 pg/mL, CKD G2: 129.7 ± 40.7 pg/mL, CKD G3: 208.1 ± 70.2 pg/mL, CKD G4: 320.2 ± 170.1 pg/mL, CKD G5: 712.8 ± 336.3 pg/mL. The reference range, calculated by a nonparametric method using 67 cases of healthy volunteers and patients with chronic kidney disease G1, was found to be 59-153 pg/mL, which was notably lower than the standard reference range currently used. Presepsin concentrations were positively correlated with a few biomarkers of renal function, indicating the necessity to consider the effect of renal function in patients with renal impairment. Using the recalculated reference range considering kidney function may improve the accuracy of evaluating presepsin for diagnosis of sepsis compared to the standard reference currently in use.
血清可溶性 CD14 亚型（sCD14-ST），一种在细菌吞噬过程中产生的糖蛋白，被用作细菌感染性脓毒症的标志物。然而，sCD14-ST 水平受肾功能的影响，根据肾功能或慢性肾脏病制定的评估标准仍存在争议。此外，sCD14-ST 可能因样本搅拌而增加，但尚无研究评估这种影响。在本研究中，我们通过标准化采血条件排除了搅拌的影响，分析了肾功能对 sCD14-ST 浓度的影响，并根据研究结果重新计算了参考范围。使用 PATHFAST 检测 EDTA-全血中的 sCD14-ST，共纳入 47 例健康受试者和 85 例慢性肾脏病患者。sCD14-ST 与肌酐（r = 0.834）、eGFRcreat（r = 0.837）、胱抑素 C（r = 0.845）和 eGFRcys（r = 0.879）水平显著相关。此外，在慢性肾脏病患者中，根据 eGFRcys 分层的 sCD14-ST 水平在 CKD G2 患者组中显著增加，并随着肾小球滤过率阶段的进展而增加。得到以下数值：正常：97.6 ± 27.4 pg/mL，CKD G1：100.2 ± 27.6 pg/mL，CKD G2：129.7 ± 40.7 pg/mL，CKD G3：208.1 ± 70.2 pg/mL，CKD G4：320.2 ± 170.1 pg/mL，CKD G5：712.8 ± 336.3 pg/mL。通过对 67 例健康志愿者和慢性肾脏病 G1 患者进行非参数法计算得出参考范围为 59-153 pg/mL，明显低于目前使用的标准参考范围。sCD14-ST 浓度与肾功能的一些生物标志物呈正相关，表明在肾功能受损的患者中需要考虑肾功能的影响。与目前使用的标准参考范围相比，使用考虑肾功能的重新计算的参考范围可能会提高评估 sCD14-ST 用于诊断脓毒症的准确性。
