Ruangsomboon Onlak, Panjaikaew Phantakarn, Monsomboon Apichaya, Chakorn Tipa, Permpikul Chairat, Limsuwat Chok
Department of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand.
Division of Critical Care, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand.
Clin Chim Acta. 2020 Nov;510:723-732. doi: 10.1016/j.cca.2020.09.014. Epub 2020 Sep 16.
Presepsin, a biomarker for sepsis diagnosis, has not been studied in very elderly population. The study aimed to evaluate the diagnostic and prognostic value of Presepsin in very elderly patients compared to point-of-care Procalcitonin (PCT), C-reactive protein (CRP), and early warning scores (EWSs).
This study prospectively enrolled 250 patients aged at least 75 years old, presenting to the Emergency Department of Siriraj Hospital with suspected sepsis during September 2019 and January 2020. They were classified into three groups: non-sepsis, sepsis, and septic shock. Biomarkers and EWS values at admission were determined. PCT was analyzed with non-BRAHM method.
Presepsin had valuable diagnostic utility for sepsis (AUC 0.792), comparable to PCT (AUC 0.751, p = 0.22) and CRP (AUC 0.767, p = 0.47). It also showed similar prognostic accuracy (AUC 0.683) with PCT (AUC 0.691, p = 0.68) and CRP (AUC 0.688, p = 0.85). The combination of Presepsin, PCT, and an EWS yielded the highest diagnostic accuracy for sepsis and septic shock and highest prognostic accuracy for 30-day mortality.
Presepsin is a valuable diagnostic and prognostic biomarker for sepsis in very elderly emergency patients. The combination of Presepsin, PCT, and an EWS was the best modality for early sepsis diagnosis and prognostication.
可溶性髓系细胞触发受体-1（Presepsin）作为脓毒症诊断的生物标志物，尚未在高龄人群中进行研究。本研究旨在评估Presepsin与即时检测降钙素原（PCT）、C反应蛋白（CRP）及早期预警评分（EWS）相比，在高龄患者中的诊断及预后价值。
本研究前瞻性纳入了250例年龄≥75岁的患者，这些患者于2019年9月至2020年1月因疑似脓毒症就诊于诗里拉吉医院急诊科。他们被分为三组：非脓毒症组、脓毒症组和脓毒性休克组。测定入院时的生物标志物和EWS值。采用非BRAHM方法分析PCT。
Presepsin对脓毒症具有重要的诊断价值（曲线下面积[AUC]为0.792），与PCT（AUC为0.751，p = 0.22）和CRP（AUC为0.767，p = 0.47）相当。其预后准确性（AUC为0.683）也与PCT（AUC为0.691，p = 0.68）和CRP（AUC为0.688，p = 0.85）相似。Presepsin、PCT和EWS联合应用对脓毒症和脓毒性休克的诊断准确性最高，对30天死亡率的预后准确性最高。
Presepsin是高龄急诊患者脓毒症的重要诊断和预后生物标志物。Presepsin、PCT和EWS联合应用是早期脓毒症诊断和预后评估的最佳模式。
