Prognostic importance of serum presepsin level in pneumonia focal sepsis and its relationship with other biomarkers and clinical severity scores.

OBJECTIVES: To analyze the prognostic value of serum presepsin value in community-acquired pneumonia focal sepsis using sepsis-3 criteria and its relationship with other biomarkers and clinical severity scores. METHODS: For this prospective observational study, 176 patients above 18 years old, diagnosed with community-acquired pneumonia, pneumonia focal sepsis and septic shock were included. It was performed in a tertiary hospital between May 2020 and December 2020. Blood samples were obtained from patients for presepsin levels at the time of diagnosis in the emergency room. The serum presepsin levels of 3 groups were statistically compared with each other. RESULTS: The sepsis group had significantly higher serum presepsin levels than the pneumonia group (p=0.004).The septic shock group had serum presepsin levels than sepsis group; however, the difference was not statistically significant (p=0.25). Non survivor patients had significantly higher serum presepsin levels than survivors (p=0.001). Significant correlation determined between serum presepsin level and procalcitonin, C-reactive protein, lactate, pneumonia severity index, and quick sequential organ failure assessment (qSOFA). CONCLUSION: Serum presepsin level is a new biomarker that can be used an indicator of sepsis and mortality in community-acquired pneumonia. However, for determining the prognosis of sepsis, there was no superiority detected over other biomarkers and clinical severity scores.

The role of the quick sequential organ failure assessment score (qSOFA) and modified early warning score (MEWS) in the pre-hospitalization prediction of sepsis prognosis.

OBJECTIVE: Many biomarkers and scoring systems to make clinical predictions about the prognosis of sepsis have been investigated. In this study, we aimed to assess the use of the quick sequential organ failure assessment score (qSOFA) and modified early warning score (MEWS) scoring systems in emergency health care services for sepsis to predict intensive care hospitalization and 28-day mortality. METHOD: Patients who arrived by ambulance at the Emergency Department (ED) of Diskapi YildirimBeyazit Training and Research Hospital between January 2017 and December 2019, and who were diagnosed with sepsis and admitted to the hospital were included in the study. Demographic data and physiological parameters from 112 ambulance case delivery forms were recorded.QSOFA and MEWS scores were calculated from vital parameters. RESULTS: Of the 266 patients diagnosed with sepsis, 50% (n = 133) were female, and the mean age was 74.8 ± 13. The difference between the rate of intensive care (ICU) hospitalization and mortality for patients with a high MEWS and qSOFA score and patients whose MEWS and qSOFA score were lower was found to be statistically significant (p < 0.05). Thus, the criteria for MEWS and qSOFA could determine ICU hospitalization and early mortality. Those with a high MEWS value had a mortality rate approximately 1.24 times higher than those with a low MEWS value (p < 0.001, 95% CI: 1.110-1.385), while those with a high qSOFA score had a mortality rate approximately 2.0 times higher than those with a low qSOFA score (p < 0.001, 95% CI: 1.446-2.693). Those with a high MEWS were 1.34 times more likely than hose with a lower MEWS to require ICU hospitalization (p < 0.001, 95% CI: 1.1773-1.5131), while patients with a high qSOFA score were 3.21 times more likely than those with a lower qSOFA score to require ICU care (p < 0.001, 95% CI: 2.2289-4.6093). CONCLUSION: Although qSOFA and MEWS are clinical scores used to identify septic patients outside the critical care unit, we believe that patients already diagnosed with sepsis can be assessed with qSOFA and MEWS prior to hospitalization to predict intensive care hospitalization and mortality. qSOFA was found be more valuable than MEWS in determining the prognosis of pre-hospitalization sepsis.

The role of presepsin in the diagnosis of chronic obstructive pulmonary disease acute exacerbation with pneumonia.

Aim: In this study, we aimed to investigate the role of presepsin in detecting concomitant pneumonia in patients presenting with acute exacerbation of chronic obstructive pulmonary disease (COPD) in the emergency department. Patients & methods: Three groups were formed in the study. Group 1: patients diagnosed with acute exacerbation of COPD; group 2: patients with acute exacerbation of COPD + pneumonia; group 3: healthy individuals. Results: Presepsin levels of the patients in group 2 were significantly higher than those of group 1 and group 3 (p < 0.05). There was a statistically significant difference in erythrocyte sedimentation rate, CRP, procalcitonin and presepsin values between two patient groups (p < 0.05). Conclusion: Presepsin can be used to diagnose pneumonia in patients with acute exacerbation of COPD admitted to the emergency department.