Department of Urology, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan.
Division of Community and Family Medicine, Department of Clinical Laboratory Medicine, Jichi Medical University, Shimotsuke, Japan.
BMC Urol. 2021 Oct 12;21(1):144. doi: 10.1186/s12894-021-00906-4.
Recently, presepsin has been reported to be a useful biomarker for early diagnosis of sepsis and evaluation of prognosis in septic patients. However, few reports have evaluated its usefulness in patients with urinary tract infections (UTI). This study aimed to evaluate whether presepsin could be a valuable marker for detecting severe sepsis, and whether it could predict the therapeutic course in patients with UTI compared with markers already used: procalcitonin (PCT) and C-reactive protein (CRP).
From April 2014 to December 2016, a total of 50 patients with urinary tract infections admitted to Gunma university hospital were enrolled in this study. Vital signs, presepsin, PCT, CRP, white blood cell (WBC) count, causative agents of urinary-tract infections, and other data were evaluated on the enrollment, third, and fifth days. The patients were divided into two groups: with (n = 11) or without (n = 39) septic shock on the enrollment day, and with (n = 7) or without (n = 43) sepsis on the fifth day, respectively. Presepsin was evaluated as a biomarker for systemic inflammatory response syndrome (SIRS) or septic shock.
Regarding the enrollment day, there was no significant difference of presepsin between the SIRS and non-SIRS groups (p = 0.276). The median value of presepsin (pg/mL) was significantly higher in the septic shock group (p < 0.001). Multivariate logistic regression analysis showed that presepsin (≥ 500 pg/ml) was an independent risk factor for septic shock (p = 0.007). ROC curve for diagnosing septic shock indicated an area under the curve (AUC) of 0.881 for presepsin (vs. 0.690, 0.583, and 0.527 for PCT, CRP and WBC, respectively). Regarding the 5th day after admission, the median presepsin value on the enrollment day was significantly higher in the SIRS groups than in the non-SIRS groups (p = 0.006). On the other hand, PCT (≥ 2 ng/ml) on the enrollment day was an independent risk factor for SIRS. ROC curve for diagnosing sepsis on the fifth day indicated an AUC of 0.837 for PCT (vs. 0.817, 0.811, and 0.802 for presepsin, CRP, and WBC, respectively).
This study showed that presepsin may be a good marker for diagnosing septic shock based on admission data in patients with UTI.
最近，促炎蛋白 14 被报道为一种有用的生物标志物，可用于早期诊断脓毒症，并评估脓毒症患者的预后。然而，很少有报道评估其在尿路感染（UTI）患者中的有用性。本研究旨在评估降钙素原（PCT）和 C 反应蛋白（CRP）等已用标志物相比，降钙素原 14 是否可以成为检测严重脓毒症的有价值的标志物，并预测 UTI 患者的治疗过程。
2014 年 4 月至 2016 年 12 月，共有 50 名尿路感染患者入住群马大学医院，纳入本研究。在入院时、第 3 天和第 5 天评估生命体征、降钙素原 14、PCT、CRP、白细胞（WBC）计数、尿路感染的病原体和其他数据。患者分为两组：入院时伴有（n=11）或不伴有（n=39）脓毒性休克，第 5 天伴有（n=7）或不伴有（n=43）脓毒症。降钙素原 14 被评估为全身性炎症反应综合征（SIRS）或脓毒性休克的生物标志物。
入院时，SIRS 组和非 SIRS 组的降钙素原 14 差异无统计学意义（p=0.276）。脓毒性休克组降钙素原 14（pg/ml）中位数明显升高（p<0.001）。多变量逻辑回归分析显示，降钙素原 14（≥500 pg/ml）是脓毒性休克的独立危险因素（p=0.007）。诊断脓毒性休克的 ROC 曲线显示降钙素原 14 的曲线下面积（AUC）为 0.881（与 PCT 的 0.690、0.583 和 0.527 相比）。关于入院后第 5 天，SIRS 组入院时的降钙素原 14 中位数明显高于非 SIRS 组（p=0.006）。另一方面，入院时的 PCT（≥2ng/ml）是 SIRS 的独立危险因素。诊断第 5 天脓毒症的 ROC 曲线显示 PCT 的 AUC 为 0.837（与降钙素原 14、CRP 和 WBC 的 0.817、0.811 和 0.802 相比）。
本研究表明，降钙素原 14 可能是 UTI 患者基于入院数据诊断脓毒性休克的良好标志物。
