Service des soins intensifs, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
Medical-Surgical Intensive Care Unit, Inserm CIC 1435 and UMR 1092, Dupuytren Teaching Hospital, Limoges, France.
Crit Care. 2021 Apr 20;25(1):151. doi: 10.1186/s13054-021-03576-8.
The early recognition and management of sepsis improves outcomes. Biomarkers may help in identifying earlier sub-clinical signs of sepsis. We explored the potential of serial measurements of C-reactive protein (CRP), procalcitonin (PCT) and pancreatic stone protein (PSP) for the early recognition of sepsis in patients hospitalized in the intensive care unit (ICU).
This was a multicentric international prospective observational clinical study conducted in 14 ICUs in France, Switzerland, Italy, and the United Kingdom. Adult ICU patients at risk of nosocomial sepsis were included. A biomarker-blinded adjudication committee identified sepsis events and the days on which they began. The association of clinical sepsis diagnoses with the trajectories of PSP, CRP, and PCT in the 3 days preceding these diagnoses of sepsis were tested for markers of early sepsis detection. The performance of the biomarkers in sepsis diagnosis was assessed by receiver operating characteristic (ROC) analysis.
Of the 243 patients included, 53 developed nosocomial sepsis after a median of 6 days (interquartile range, 3-8 days). Clinical sepsis diagnosis was associated with an increase in biomarkers value over the 3 days preceding this diagnosis [PSP (p = 0.003), PCT (p = 0.025) and CRP (p = 0.009)]. PSP started to increase 5 days before the clinical diagnosis of sepsis, PCT 3 and CRP 2 days, respectively. The area under the ROC curve at the time of clinical sepsis was similar for all markers (PSP, 0.75; CRP, 0.77; PCT, 0.75).
While the diagnostic accuracy of PSP, CRP and PCT for sepsis were similar in this cohort, serial PSP measurement demonstrated an increase of this marker the days preceding the onset of signs necessary to clinical diagnose sepsis. This observation justifies further evaluation of the potential clinical benefit of serial PSP measurement in the management of critically ill patients developing nosocomial sepsis. Trial registration The study has been registered at ClinicalTrials.gov (no. NCT03474809), on March 16, 2018. https://www.clinicaltrials.gov/ct2/show/NCT03474809?term=NCT03474809&draw=2&rank=1 .
早期识别和处理脓毒症可改善预后。生物标志物可能有助于更早地识别脓毒症的亚临床迹象。我们探索了连续测量 C 反应蛋白（CRP）、降钙素原（PCT）和胰腺结石蛋白（PSP）在识别 ICU 住院患者脓毒症中的潜力。
这是一项在法国、瑞士、意大利和英国的 14 个 ICU 进行的多中心国际前瞻性观察性临床研究。纳入有医院获得性脓毒症风险的成年 ICU 患者。一个生物标志物盲法裁决委员会确定脓毒症事件及其开始日期。在这些脓毒症诊断前的 3 天内，测试临床脓毒症诊断与 PSP、CRP 和 PCT 轨迹之间的关联，以寻找早期脓毒症检测的标志物。通过接收者操作特征（ROC）分析评估生物标志物在脓毒症诊断中的性能。
在纳入的 243 例患者中，中位时间为 6 天（四分位距 3-8 天）后 53 例发生医院获得性脓毒症。临床脓毒症诊断与诊断前 3 天内生物标志物值的升高相关[PSP（p=0.003）、PCT（p=0.025）和 CRP（p=0.009）]。PSP 在临床诊断脓毒症前 5 天开始升高，PCT 在 3 天，CRP 在 2 天。在临床脓毒症发生时，ROC 曲线下面积在所有标志物中相似（PSP：0.75；CRP：0.77；PCT：0.75）。
在本队列中，PSP、CRP 和 PCT 对脓毒症的诊断准确性相似，连续 PSP 测量显示该标志物在出现临床诊断脓毒症所需的迹象前几天增加。这一观察结果证明了进一步评估连续 PSP 测量在管理发生医院获得性脓毒症的危重症患者中的潜在临床获益是合理的。
该研究于 2018 年 3 月 16 日在 ClinicalTrials.gov 上注册（编号：NCT03474809）。https://www.clinicaltrials.gov/ct2/show/NCT03474809?term=NCT03474809&draw=2&rank=1 。
