Zong Xinxin, Liu Yongzhe, Gu Li, Chen Xi, Yang Chunxia
Department of Infectious Diseases and Clinical Microbiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing 100020, China. Corresponding author: Yang Chunxia, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2024 Apr;36(4):340-344. doi: 10.3760/cma.j.cn121430-20230828-00700.
To analyze the early diagnostic value of plasma soluble cluster of differentiation 14 subtype (sCD14-ST, Presepsin) in sepsis in a population with suspected sepsis in fever clinic.
A prospective observational study was conducted. The patients admitted to the fever clinic of Beijing Chaoyang Hospital from April to December 2022 were enrolled as the study objects. According to sequential organ failure assessment (SOFA) score, the patients were divided into low SOFA score group (SOFA score ≤3) and high SOFA score group (SOFA score > 3). Venous blood was collected at the time of admission. The level of plasma Presepsin was detected by chemiluminescence enzyme-linked immunoassay. The level of plasma procalcitonin (PCT) was detected by enzyme-linked immunofluorescence method. The level of C-reactive protein (CRP) was detected by scattering turbidimetry. White blood cell count (WBC) and neutrophil count (NEUT) were measured by automatic blood cell analyzer. For patients with fear of cold or chills, venous blood of upper limbs was taken for blood culture at the time of admission. The differences in inflammatory biomarkers were compared between the two groups. Binary multivariate Logistic regression analysis was used to screen the early risk factors of sepsis in fever outpatients with suspected sepsis. Receiver operator characteristic curve (ROC curve) was drawn to investigate the early diagnostic value of Presepsin and other inflammatory markers in sepsis, and to analyze the optimal cut-off value.
A total of 149 fever outpatients with suspected sepsis were enrolled, including 92 patients with low SOFA score and 57 patients with high SOFA score. Plasma PCT and Presepsin levels in the high SOFA score group were significantly higher than those in the low SOFA score group [PCT (μg/L): 0.77 (0.18, 2.02) vs. 0.22 (0.09, 0.71), Presepsin (ng/L): 1 129.00 (785.50, 1 766.50) vs. 563.00 (460.50, 772.25), both P < 0.01]. There was no significant difference in WBC, NEUT, CRP or positive rate of blood culture between the high and low SOFA score groups [WBC (×10/L): 11.32±5.47 vs. 11.14±5.29, NEUT (×10/L): 9.88±4.89 vs. 9.60±5.10, CRP (mg/L): 54.05 (15.95, 128.90) vs. 46.11 (19.60, 104.60), blood culture positivity rate: 42.3% (11/26) vs. 29.4% (10/34), all P > 0.05]. Multivariate Logistic regression analysis showed that Presepsin was an early risk factor for sepsis in suspected sepsis patients in fever clinics [odds ratio (OR) = 16.96, 95% confidence interval (95%CI) was 6.35-45.29, P = 0.000]. ROC curve analysis showed that the early diagnostic value of Presepsin in sepsis was significantly better than WBC, NEUT, CRP, PCT, and blood culture [the area under the ROC curve (AUC) and 95%CI: 0.832 (0.771-0.899) vs. 0.522 (0.424-0.619), 0.532 (0.435-0.629), 0.533 (0.435-0.632), 0.664 (0.574-0.753), 0.554 (0.458-0.650)]. When the optimal cut-off value of Presepsin was 646.50 ng/L, its sensitivity and positive predictive value were higher than those of WBC, NEUT, CRP, and PCT (sensitivity: 89.5% vs. 38.6%, 68.4%, 38.6%, 57.9%; positive predictive value: 64.6% vs. 44.9%, 44.3%, 47.8%, 55.9%).
Plasma PCT and Presepsin have early diagnostic value for sepsis in suspected sepsis patients in fever clinics, and Presepsin is more sensitive than PCT and can be used as an early marker of sepsis.
分析血浆可溶性分化簇14亚型（sCD14-ST，可溶性髓系细胞触发受体-1）在发热门诊疑似脓毒症人群中对脓毒症的早期诊断价值。
进行一项前瞻性观察性研究。将2022年4月至12月在北京朝阳医院发热门诊就诊的患者纳入研究对象。根据序贯器官衰竭评估（SOFA）评分，将患者分为低SOFA评分组（SOFA评分≤3）和高SOFA评分组（SOFA评分>3）。入院时采集静脉血。采用化学发光酶联免疫分析法检测血浆可溶性髓系细胞触发受体-1水平。采用酶联免疫荧光法检测血浆降钙素原（PCT）水平。采用散射比浊法检测C反应蛋白（CRP）水平。采用自动血细胞分析仪检测白细胞计数（WBC）和中性粒细胞计数（NEUT）。对于有畏寒或寒战的患者，入院时采集上肢静脉血进行血培养。比较两组炎症生物标志物的差异。采用二元多变量Logistic回归分析筛选发热门诊疑似脓毒症患者脓毒症的早期危险因素。绘制受试者工作特征曲线（ROC曲线），探讨可溶性髓系细胞触发受体-1和其他炎症标志物对脓毒症的早期诊断价值，并分析最佳截断值。
共纳入149例发热门诊疑似脓毒症患者，其中低SOFA评分组92例，高SOFA评分组57例。高SOFA评分组血浆PCT和可溶性髓系细胞触发受体-1水平显著高于低SOFA评分组[PCT（μg/L）：0.77（0.18，2.02） vs. 0.22（0.09，0.71），可溶性髓系细胞触发受体-1（ng/L）：1129.00（785.50，1766.50） vs. 563.00（460.50，772.25），均P<0.01]。高、低SOFA评分组之间WBC、NEUT、CRP或血培养阳性率无显著差异[WBC（×10⁹/L）：11.32±5.47 vs. 11.14±5.29，NEUT（×10⁹/L）：9.88±4.89 vs. 9.60±5.10，CRP（mg/L）：54.05（15.95，128.90） vs. 46.11（19.60，104.60），血培养阳性率：42.3%（11/26） vs. 29.4%（10/34），均P>0.05]。多变量Logistic回归分析显示，可溶性髓系细胞触发受体-1是发热门诊疑似脓毒症患者脓毒症的早期危险因素[比值比（OR）=16.96，95%置信区间（95%CI）为6.35-45.29，P=0.000]。ROC曲线分析显示，可溶性髓系细胞触发受体-1对脓毒症的早期诊断价值显著优于WBC、NEUT、CRP、PCT和血培养[ROC曲线下面积（AUC）及95%CI：0.832（0.771-0.899） vs. 0.522（0.424-0.619）、0.532（0.435-0.629）、0.533（0.435-0.632）、0.664（0.574-0.753）、0.554（0.458-0.650）]。当可溶性髓系细胞触发受体-1的最佳截断值为646.50 ng/L时，其敏感性和阳性预测值高于WBC、NEUT、CRP和PCT（敏感性：89.5% vs. 38.6%、68.4%、38.6%、57.9%；阳性预测值：64.6% vs. 44.9%、44.3%、47.8%及55.％）。
血浆PCT和可溶性髓系细胞触发受体-1对发热门诊疑似脓毒症患者脓毒症有早期诊断价值，且可溶性髓系细胞触发受体-1比PCT更敏感，可作为脓毒症的早期标志物。
