The early diagnostic value and prognostic significance of serum presepsin (sCD14-ST)in patients with sepsis / 中华急诊医学杂志

ABSTRACT

Objective To investigate the early diagnostic value and prognostic significance of serum presepsin in patients with sepsis.Methods A prospective observational study of 80 patients from ICU was carried out between January 2014 and June 2015.According to sepsis criteria,the cases were divided into sepsis group (n =50)and noninfectious systemic inflammation syndrome group (SIRS group,n =30), and another 25 healthy volunteers were collected as control group.Meanwhile,sepsis group was further divided into survival and death subgroups according to 28-day mortality.The dynamic changes of serum presepsin,procalcitonin (PCT),soluble myeloid cells expressing triggering receptor-1 (sTREM-1 ),C-reactive protein (CRP),interleukin 6 (IL-6)were monitored on the 1st,3rd and 7th day after admission. Results (1)The serum presepsin level of sepsis group was higher than SIRS group and control group on the 1st day,and the difference was statistically significant [912.0 (563.5,1514.8)pg/mL vs.462.0 (334.0,556.0)pg/mL vs.120.0 (70.2,320.1)pg/mL,P <0.05];(2)The area under the ROC curve (AUC)of presepsin for the sepsis diagnosis was greater than PCT,sTREM-1,CRP,IL-6.As cut-off point set at 672.5 pg/mL,presepsin measurements showed a sensitivity of 80%,specificity of 96.7%, combination of presepsin,PCT and sTREM-1 could offer better diagnostic confirmation;(3)The level of serum presepsin,PCT and sTREM-1 in death group were higher than those in survival group.The levels of serum presepsin,PCT,sTREM-1 and IL-6 in survival group gradually decreased to normal level following the therapy,but the levels of above markers in death group didn’t decrease significantly;(4)The AUC of presepsin in prognosis of sepsis prediction was greater than that of PCT,sTREM-1,and combination of the above three markers could offer better prognostic value.Conclusions Serum presepsin provided superior diagnostic and prognostic accuracy to PCT and sTREM-1,and the combination of presepsin,PCT and sTREM-1 can offer the reliable guide for sepsis diagnosis and death risk prediction.