Lee Gun-Hyuk, Kim Hanah, Moon Hee-Won, Yun Yeo-Min, Park Mikyoung, Lee Seungho, Hur Mina
Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul 05030, Republic of Korea.
Department of Laboratory Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea.
Diagnostics (Basel). 2024 Sep 19;14(18):2076. doi: 10.3390/diagnostics14182076.
Pancreatic stone protein (PSP) is an emerging biomarker of sepsis that is secreted from pancreas sensing remote organ damages. We explored the diagnostic and prognostic utilities of PSP in patients with suspected sepsis. In a total of 285 patients (suspected sepsis, = 148; sepsis, = 137), we compared PSP with procalcitonin (PCT) and sequential organ failure assessment (SOFA) score. Sepsis diagnoses were explored using receiver operating characteristic curve analyses with area under the curves (AUCs). Clinical outcomes (in-hospital mortality, 30-day mortality, and kidney replacement therapy [KRT]) were explored using the Kaplan-Meier method and a multivariate analysis with hazard ratio (HR). PCT and PSP were comparable for sepsis diagnosis (AUC = 0.71-0.72, < 0.001). The sepsis proportion was significantly higher when both biomarkers increased than when either one or both biomarkers did not increase (89.0% vs. 21.3-47.7%, < 0.001). Each biomarker quartile (Q1-Q4) differed significantly according to their SOFA score (all < 0.001). Compared with Q1, the Q2-Q4 groups showed worse clinical outcomes ( = 0.002-0.041). Both biomarkers added to the SOFA score showed higher HRs than the SOFA score alone (3.3-9.6 vs. 2.8-4.2, < 0.001-0.011), with nearly 2.5-fold higher HR (9.6 vs. 4.2) for predicting KRT. Although PCT and PSP did not independently predict clinical outcomes in the multivariate analysis, PSP demonstrated diagnostic and prognostic utilities in patients with suspected sepsis, especially for predicting kidney dysfunction. PSP, alone or in combination with PCT, would be a valuable tool that can be added to clinical assessments.
胰腺结石蛋白（PSP）是一种新兴的脓毒症生物标志物，由胰腺分泌，可感知远处器官损伤。我们探讨了PSP在疑似脓毒症患者中的诊断和预后效用。在总共285例患者（疑似脓毒症患者148例；脓毒症患者137例）中，我们将PSP与降钙素原（PCT）和序贯器官衰竭评估（SOFA）评分进行了比较。使用曲线下面积（AUC）的受试者工作特征曲线分析来探讨脓毒症诊断。使用Kaplan-Meier方法和危险比（HR）的多变量分析来探讨临床结局（住院死亡率、30天死亡率和肾脏替代治疗[KRT]）。PCT和PSP在脓毒症诊断方面具有可比性（AUC = 0.71 - 0.72，P < 0.001）。当两种生物标志物均升高时，脓毒症比例显著高于其中一种或两种生物标志物均未升高时（89.0%对21.3% - 47.7%，P < 0.001）。根据SOFA评分，每个生物标志物四分位数（Q1 - Q4）存在显著差异（均P < 0.001）。与Q1相比，Q2 - Q4组的临床结局更差（P = 0.002 - 0.041）。将两种生物标志物添加到SOFA评分中显示出比单独使用SOFA评分更高的HR（3.3 - 9.6对2.8 - 4.2，P < 0.001 - 0.011），预测KRT时HR高出近2.5倍（9.6对4.2）。尽管在多变量分析中PCT和PSP不能独立预测临床结局，但PSP在疑似脓毒症患者中显示出诊断和预后效用，尤其是在预测肾功能障碍方面。PSP单独或与PCT联合使用，将是一种可添加到临床评估中的有价值工具。
