Bösch Florian, Schallhorn Sven, Miksch Rainer Christoph, Chaudry Irshad H, Faist Eugen, Werner Jens, Angele Martin K, Pratschke Sebastian
Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Shock. 2020 Jul;54(1):56-61. doi: 10.1097/SHK.0000000000001479.
Rapid diagnosis accompanied by appropriate treatment is essential in the therapy of sepsis. However, there is no blood marker available, which reliably predicts sepsis and associated mortality. Therefore, the aim of the present study was to evaluate presepsin and endotoxin in comparison with established blood markers in patients undergoing emergency visceral surgery for abdominal infection.
This prospective study included 31 patients with abdominal infection undergoing emergency surgery between March and August 2014. The Sepsis-2 and Sepsis-3 definitions of sepsis were used. Blood markers (presepsin, endotoxin, C-reactive protein, procalcitonin (PCT), interleukin 6 (IL-6), white blood count) were analyzed preoperatively and correlated with the clinical course and mortality. Additionally, a combination of the three markers, which performed best, was tested.
Twenty patients (64.5%) in the analyzed cohort developed sepsis from an abdominal focus according to the latest sepsis definition. Out of the analyzed blood markers, presepsin exhibited the highest area under the curve, sensitivity, and specificity for the prediction of the development of sepsis. Moreover, presepsin had the highest predictive value for mortality as opposed to both endotoxin and previously established blood markers (i.e., PCT, IL-6). The multimarker approach, which included PCT, IL-6, and presepsin, showed no additional predictive value over presepsin alone.
The present study suggests that presepsin is a novel predictor of sepsis and mortality from sepsis in patients undergoing surgery for intra-abdominal infections. The findings of the present study should be validated in a larger cohort.
在脓毒症治疗中，快速诊断并给予适当治疗至关重要。然而，目前尚无能够可靠预测脓毒症及其相关死亡率的血液标志物。因此，本研究旨在对比 presepsin 和内毒素与既定血液标志物，评估接受腹部感染急诊内脏手术患者的情况。
本前瞻性研究纳入了 2014 年 3 月至 8 月期间 31 例接受急诊手术的腹部感染患者。采用脓毒症的 Sepsis-2 和 Sepsis-3 定义。术前分析血液标志物（presepsin、内毒素、C 反应蛋白、降钙素原（PCT）、白细胞介素 6（IL-6）、白细胞计数），并将其与临床病程及死亡率进行关联分析。此外，还对表现最佳的三种标志物组合进行了测试。
根据最新脓毒症定义，分析队列中的 20 例患者（64.5%）因腹部病灶发展为脓毒症。在所分析的血液标志物中，presepsin 在预测脓毒症发生方面曲线下面积、敏感性和特异性最高。此外，与内毒素和先前既定的血液标志物（即 PCT、IL-6）相比，presepsin 对死亡率的预测价值最高。包含 PCT、IL-6 和 presepsin 的多标志物方法相较于单独使用 presepsin 并无额外预测价值。
本研究表明，presepsin 是接受腹部感染手术患者脓毒症及脓毒症死亡率的新型预测指标。本研究结果应在更大队列中进行验证。
