Division of Pediatric Critical Care Medicine, Faculty of Medicine, Erciyes University, Kayseri, Turkiye.
Turk J Med Sci. 2024 Jul 7;54(4):744-751. doi: 10.55730/1300-0144.5844. eCollection 2024.
BACKGROUND/AIM: Early detection and prognosis of sepsis in critically ill children is crucial. The aim of this research was to investigate the prognostic ability of pancreatic stone protein (PSP) in validating sepsis and predicting mortality in a prospective observational study.
In a single-center study, pediatric intensive care unit patients were divided into cohorts of confirmed and suspected sepsis, as well as survivors and nonsurvivors. Patients with positive blood culture growth were considered to have confirmed sepsis, while their negative counterparts were considered to have suspected sepsis. Comparisons were made between complete blood counts, laboratory parameters, mortality indices, and C-reactive protein (CRP), procalcitonin (PCT), and PSP levels. The correlations between PSP and alternative inflammatory markers and mortality indices were then analyzed. The diagnostic and prognostic applicability of PSP for sepsis confirmation and mortality prediction was assessed using receiver operating characteristic curve analysis.
PSP levels were significantly elevated in patients with confirmed sepsis and within the nonsurvivor segment. In confirming sepsis and predicting mortality, PSP outperformed CRP and PCT in terms of sensitivity. It had sensitivity of 95% in diagnosing sepsis at a cut-off level of 50 ng/L, with an area under the curve (AUC) of 0.67 (95% CI: 0.52-0.81), and sensitivity of 92% in predicting mortality, with an AUC of 0.71 (95% CI: 0.56-0.83). In addition, PSP showed significant correlations with CRP, PCT, and mortality scores.
PSP is emerging as a highly sensitive marker for confirming sepsis and predicting mortality in critically ill pediatric patients. Incorporating the PSP biomarker into routine clinical practice could potentially improve the management of pediatric sepsis.
背景/目的：早期发现和预测危重症患儿脓毒症至关重要。本研究旨在通过前瞻性观察研究，探讨胰腺结石蛋白（PSP）在验证脓毒症和预测死亡率方面的预后能力。
在单中心研究中，儿科重症监护病房患者分为确诊脓毒症和疑似脓毒症组，以及幸存者和非幸存者组。血培养阳性的患者被认为患有确诊脓毒症，而血培养阴性的患者则被认为患有疑似脓毒症。比较了全血细胞计数、实验室参数、死亡率指标以及 C 反应蛋白（CRP）、降钙素原（PCT）和 PSP 水平。然后分析了 PSP 与替代炎症标志物和死亡率指标之间的相关性。使用受试者工作特征曲线分析评估 PSP 对脓毒症确诊和死亡率预测的诊断和预后适用性。
确诊脓毒症患者和非幸存者组的 PSP 水平明显升高。在确诊脓毒症和预测死亡率方面，PSP 在敏感性方面优于 CRP 和 PCT。PSP 诊断脓毒症的截断值为 50ng/L 时，敏感性为 95%，曲线下面积（AUC）为 0.67（95%CI：0.52-0.81），预测死亡率的敏感性为 92%，AUC 为 0.71（95%CI：0.56-0.83）。此外，PSP 与 CRP、PCT 和死亡率评分均呈显著相关。
PSP 是一种高度敏感的标志物，可用于确认危重症儿科患者的脓毒症并预测死亡率。将 PSP 生物标志物纳入常规临床实践可能有助于改善儿科脓毒症的管理。
