Department of Medical Technology, Tokushima University Hospital, Tokushima, Japan.
Department of Medical Technology, Kagawa Prefectural University of Health Sciences, Kagawa, Japan.
J Med Invest. 2021;68(1.2):105-111. doi: 10.2152/jmi.68.105.
Background : Presepsin (P-SEP) is a highly specific sepsis marker, and its fluctuation with respect to advanced renal impairment or sample agitation has not been fully investigated. We evaluated several renal function-corrected P-SEP indices to establish a simple index and its reference range. Methods : Blood samples for P-SEP measurement were collected with minimal agitation. P-SEP levels were measured using the rapid automated immunoanalyzer "PATHFAST." This study included 85 chronic kidney disease (CKD) patients, 65 healthy volunteers, and 4 sepsis patients. Results : Patients stratified by estimated glomerular filtration rate (GFR) had significantly higher P-SEP levels for CKD stage G3, especially the advanced GFR stage. We evaluated presepsin / creatinine (P-SEP / CRE) and P-SEP / eGFR ratios as possible indices for renal function. The P-SEP / CRE ratio exhibited no increase correlating with the GFR stage and was identical in the normal and CKD groups ; P-SEP / eGFR decreased if GFR stage worsened. The P-SEP / CRE ratio became significantly higher in sepsis patients and was a more useful index with a reference range of 67-263. Conclusions : P-SEP levels were inversely correlated with renal function, indicating the necessity to consider the influence of renal impairment in CKD patients. The P-SEP / CRE ratio is helpful for sepsis diagnosis, even in patients with renal impairment. J. Med. Invest. 68 : 105-111, February, 2021.
P-选择素（P-SEP）是一种高度特异的脓毒症标志物，其波动与肾功能衰竭或样本搅拌有关尚未得到充分研究。我们评估了几种肾功能校正的 P-SEP 指数，以建立一个简单的指数及其参考范围。方法：采用最小搅拌法采集 P-SEP 测量的血液样本。使用快速自动免疫分析仪“PATHFAST”测量 P-SEP 水平。这项研究包括 85 例慢性肾脏病（CKD）患者、65 名健康志愿者和 4 名脓毒症患者。结果：按估计肾小球滤过率（GFR）分层的患者 GFR 第 3 期（CKD 期 G3）的 P-SEP 水平明显较高，尤其是晚期 GFR 阶段。我们评估了 P-SEP/肌酐（P-SEP/CRE）和 P-SEP/估算肾小球滤过率（eGFR）的比值作为肾功能的可能指标。P-SEP/CRE 比值与 GFR 阶段无相关性增加，在正常和 CKD 组中相同；GFR 阶段恶化时，P-SEP/CRE 比值降低。P-SEP/CRE 比值在脓毒症患者中显著升高，是一种更有用的指标，其参考范围为 67-263。结论：P-SEP 水平与肾功能呈负相关，表明有必要考虑 CKD 患者肾功能受损的影响。P-SEP/CRE 比值有助于脓毒症的诊断，即使在肾功能受损的患者中也是如此。医学研究杂志 68:105-111,2021 年 2 月。
