Diagnostic accuracy of presepsin (soluble CD14 subtype) for prediction of bacteremia in patients with systemic inflammatory response syndrome in the Emergency Department
Diagnostic accuracy of presepsin (soluble CD14 subtype) for prediction of bacteremia in patients with systemic inflammatory response syndrome in the Emergency Department
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DOI：
10.1016/j.clinbiochem.2014.02.011
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发表时间：
2014-05-01
影响因子：
2.8
通讯作者：
Albaladejo Oton, Maria Dolores
中科院分区：
文献类型：
--
作者：
de Guadiana Romualdo, Luis Garcia;Esteban Torrella, Patricia;Albaladejo Oton, Maria Dolores
背景：菌血症是严重细菌感染的标志，死亡率高。其早期诊断对抗菌药物治疗的实施极为重要，但也是一项诊断挑战。虽然血培养是诊断菌血症的“金标准”，但这种方法在早期发现血流感染方面用处有限。在这项研究中，我们评估了胃蛋白酶作为急诊科入院时全身性炎症反应综合征（SIRS）患者菌血症的预测因子，并将其与当前可用的感染生物标志物进行比较。方法：纳入急诊收治的226例SIRS患者。37例患者血培养阳性（菌血症组），189例患者血培养阴性（非菌血症组）。与血培养同时测定血凝素、降钙素原（PCT）、c反应蛋白（CRP）。受试者工作特征（ROC）曲线分析作为菌血症的预测指标。结果：菌血症SIRS组Presepsin值明显高于非菌血症SIRS组。ROC曲线分析和曲线下面积（AUC）显示，presepsin在SIRS患者是否存在菌血症中的鉴别价值为0.750，与PCT相似（0.787），高于CRP（0.602）。presepsin的最佳临界值为729 pg/mL，阴性预测值为94.4%。结论：在急诊科收治的SIRS患者中应用Presepsin可能有助于排除菌血症的诊断。(C) 2014加拿大临床化学学会。Elsevier Inc.出版。版权所有。
Background: Bacteremia is indicative of severe bacterial infection with significant mortality. Its early diagnosis is extremely important for implementation of antimicrobial therapy but a diagnostic challenge. Although blood culture is the "gold standard" for diagnosis of bacteremia this method has limited usefulness for the early detection of blood-stream infection. In this study we assessed the presepsin as predictor of bacteremia in patients with systemic inflammatory response syndrome (SIRS) on admission to the Emergency Department and compare it with current available infection biomarkers.Methods: A total of 226 patients admitted to the Emergency Department with SIRS were included. In 37 patients blood culture had a positive result (bacteremic SIRS group) and 189 had a negative blood culture result (non-bacteremic SIRS group). Simultaneously with blood culture, presepsin, procalcitonin (PCT) and C-reactive protein (CRP) were measured. Receiver operating characteristic (ROC) curve analysis was performed for each biomarker as predictor of bacteremia.Results: Presepsin values were significantly higher in bacteremic SIRS group when compared with non-bacteremic SIRS group. ROC curve analysis and area under curve (AUC) revealed a value of 0.750 for presepsin in differentiating SIRS patients with bacteremia from those without, similar than that for PCT (0.787) and higher than that for CRP (0.602). The best cut-off value for presepsin was 729 pg/mL, which was associated with a negative predictive value of 94.4%.Conclusion: Presepsin may contribute to rule out the diagnosis of bacteremia in SIRS patients admitted to the Emergency Department. (C) 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.