Diagnostic value and prognostic evaluation of Presepsin for sepsis in an emergency department.
Diagnostic value and prognostic evaluation of Presepsin for sepsis in an emergency department.
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DOI：
10.1186/cc13070
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发表时间：
2013-10-20
期刊：
影响因子：
--
通讯作者：
Li CS
中科院分区：
文献类型：
--
作者：
Liu B;Chen YX;Yin Q;Zhao YZ;Li CS
已知脓毒症患者的前体素水平升高。本研究的目的是比较前降钙素(PCT)、急诊科脓毒症死亡率(MEDS)和急性生理学和慢性健康状况评估II(APACHE II)评分对急诊科脓毒症患者早期诊断和预后的价值，并探讨前降钙素作为一种新的脓毒症生物标志物的价值。本研究纳入了2011年12月至2012年10月在北京朝阳医院急诊科住院的859例符合至少两个全身炎症反应综合征(SIRS)诊断标准的患者和100名年龄匹配的健康对照组。患者被分成四组：全身炎症反应综合征、败血症、严重败血症和感染性休克。在入选时检测血浆Preepsin和血清PCT，并计算MEDS评分和APACHE II评分。采用Kruskal-Wallis和Mann-Whitney U检验进行比较分析。入院时，血浆前降压素水平的中位数随着脓毒症严重程度的增加而增加。Presepsin的受试者工作特征(AUC)曲线下面积大于PCT的AUC曲线下面积，可预测严重的脓毒症和感染性休克。Presepsin预测脓毒症患者28d死亡率的AUC略低于PCT、MEDS评分和APACHE II评分。Preepsin与MEDS评分或APACHE II评分联合应用预测严重脓毒症的AUC显著高于单独使用MEDS评分或APACHE II评分，在预测脓毒症患者感染性休克和28d病死率方面显著高于单独使用Presepsin。在28天的随访中，败血症患者死亡患者的血浆Presepsin水平显著高于存活患者。Preepsin、MEDS评分和APACHE II评分是脓毒症患者严重脓毒症、感染性休克和28天死亡率的独立预测因子。各脓毒症组血浆Presepsin水平与PCT、MEDS评分、APACHE II评分呈正相关。Preepsin是一种有价值的生物标志物，可用于急诊室脓毒症患者的早期诊断、风险分层和预后评估。
Presepsin levels are known to be increased in sepsis. The aim of this study was to evaluate the early diagnostic and prognostic value of Presepsin compared with procalcitonin (PCT), Mortality in Emergency Department Sepsis (MEDS) score and Acute Physiology and Chronic Health Evaluation II (APACHE II) score in septic patients in an emergency department (ED) and to investigate Presepsin as a new biomarker of sepsis. This study enrolled 859 consecutive patients with at least two diagnostic criteria for systemic inflammatory response syndrome (SIRS) who were admitted to Beijing Chao-yang Hospital ED from December 2011 to October 2012, and 100 age-matched healthy controls. Patients were stratified into four groups: SIRS, sepsis, severe sepsis, and septic shock. Plasma Presepsin and serum PCT were measured, and MEDS score and APACHE II score were calculated at enrollment. Comparisons were analyzed using the Kruskal-Wallis and Mann–Whitney U tests. On admission, the median levels of plasma Presepsin increased with sepsis severity. The areas under the receiver operating characteristic (AUC) curves of Presepsin were greater than those of PCT in diagnosing sepsis, and predicting severe sepsis and septic shock. The AUC of Presepsin for predicting 28-day mortality in septic patients was slightly lower than that of PCT, MEDS score and APACHE II score. The AUC of a combination of Presepsin and MEDS score or APACHE II score was significantly higher than that of MEDS score or APACHE II score alone in predicting severe sepsis, and was markedly higher than that of Presepsin alone in predicting septic shock and 28-day mortality in septic patients, respectively. Plasma Presepsin levels in septic patients were significantly higher in non-survivors than in survivors at 28 days’ follow-up. Presepsin, MEDS score and APACHE II score were found to be independent predictors of severe sepsis, septic shock and 28-day mortality in septic patients. The levels of plasma Presepsin were positively correlated with PCT, MEDS score and APACHE II score in every septic group. Presepsin is a valuable biomarker for early diagnosis of sepsis, risk stratification, and evaluation of prognosis in septic patients in the ED.
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