1887

Abstract

Early diagnosis and prompt targeted therapy are essential for septic patients’ outcome. Procalcitonin (PCT) has been shown to predict bacteraemia and bacterial DNAaemia. Presepsin, the circulating soluble form of CD14 subtype, increases in response to bacterial infections, and is considered a new, emerging, early marker for sepsis. We evaluated the diagnostic accuracy of presepsin in predicting bacteraemia and bacterial DNAaemia in 92 patients with suspected sepsis, and we compared it with that of PCT and C-reactive protein (CRP). Presepsin median values were significantly higher in bacteraemic vs non-bacteraemic patients [1290 pg ml, interquartile range (IQR) 1005–2041 vs 659 pg ml, IQR 381–979; P<0.001] and in patients with vs patients without bacterial DNAaemia (1297 pg ml, IQR 1001–2046 vs 665 pg ml, IQR 381–940; P<0.001). Receiver operating characteristics analysis showed an area under the curve (AUC) for presepsin of 0.788 [95 % confidence interval (CI): 0.687–0.889; P<0.001] in predicting bacteraemia and of 0.777 (95 % CI: 0.676–0.878; P<0.001) in predicting bacterial DNAaemia, lower, but not significantly different, than those of PCT (0.876, P=0.12 and 0.880, P=0.07, respectively). Both biomarkers performed significantly better than CRP, which had an AUC for bacteraemia of 0.602 and for DNAaemia of 0.632 (all P values <0.05). In conclusion, in patients with suspected sepsis, presepsin and PCT showed a good diagnostic accuracy in predicting both bacteraemia and bacterial DNAaemia, superior to CRP.

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2016-08-01
2019-10-18
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References

  1. Barati M., Alinejad F., Bahar M. A., Tabrisi M. S., Shamshiri A. R., Bodouhi N. O., Karimi H..( 2008;). Comparison of WBC, ESR, CRP and PCT serum levels in septic and non-septic burn cases. . Burns 34: 770–774. [CrossRef] [PubMed]
    [Google Scholar]
  2. Bone R. C., Balk R. A., Cerra F. B., Dellinger R. P., Fein A. M., Knaus W. A., Schein R. M., Sibbald W. J..( 1992;). Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. . Chest 101: 1644–1655. [CrossRef] [PubMed]
    [Google Scholar]
  3. Chenevier-Gobeaux C., Borderie D., Weiss N., Mallet-Coste T., Claessens Y. E..( 2015;). Presepsin (sCD14-ST), an innate immune response marker in sepsis. . Clin Chim Acta 450: 97–103. [CrossRef] [PubMed]
    [Google Scholar]
  4. Cho S. Y., Choi J. H..( 2014;). Biomarkers of sepsis. . Infect Chemother 46: 1–12. [CrossRef] [PubMed]
    [Google Scholar]
  5. Dark P., Blackwood B., Gates S., McAuley D., Perkins G. D., McMullan R., Wilson C., Graham D., Timms K. et al.( 2015;). Accuracy of LightCycler® SeptiFast for the detection and identification of pathogens in the blood of patients with suspected sepsis: a systematic review and meta-analysis. . Intensive Care Med 41: 21–33. [CrossRef] [PubMed]
    [Google Scholar]
  6. Darton T., Guiver M., Naylor S., Jack D. L., Kaczmarski E. B., Borrow R., Read R. C..( 2009;). Severity of meningococcal disease associated with genomic bacterial load. . Clin Infect Dis 48: 587–594. [CrossRef] [PubMed]
    [Google Scholar]
  7. Dellinger R. P., Levy M. M., Rhodes A., Annane D., Gerlach H., Opal S. M., Sevransky J. E., Sprung C. L., Douglas I. S. et al.( 2013;). Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. . Crit Care Med 41: 580–637. [CrossRef] [PubMed]
    [Google Scholar]
  8. Endo S., Suzuki Y., Takahashi G., Shozushima T., Ishikura H., Murai A., Nishida T., Irie Y., Miura M. et al.( 2012;). Usefulness of presepsin in the diagnosis of sepsis in a multicenter prospective study. . J Infect Chemother 18: 891–897. [CrossRef] [PubMed]
    [Google Scholar]
  9. Henriquez-Camacho C., Losa J..( 2014;). Biomarkers for sepsis. . Biomed Res Int 2014: 547818. [CrossRef] [PubMed]
    [Google Scholar]
  10. Ho Y. C., Chang S. C., Lin S. R., Wang W. K..( 2009;). High levels of mecA DNA detected by a quantitative real-time PCR assay are associated with mortality in patients with methicillin-resistant Staphylococcus aureus bacteremia. . J Clin Microbiol 47: 1443–1451. [CrossRef] [PubMed]
    [Google Scholar]
  11. Hoeboer S. H., van der Geest P. J., Nieboer D., Groeneveld A. B..( 2015;). The diagnostic accuracy of procalcitonin for bacteraemia: a systematic review and meta-analysis. . Clin Microbiol Infect 21: 474–481. [CrossRef] [PubMed]
    [Google Scholar]
  12. Hoenigl M., Raggam R. B., Wagner J., Prueller F., Grisold A. J., Leitner E., Seeber K., Prattes J., Valentin T. et al.( 2014;). Procalcitonin fails to predict bacteremia in SIRS patients: a cohort study. . Int J Clin Pract 68: 1278–1281. [CrossRef] [PubMed]
    [Google Scholar]
  13. Kirkbright S., Fatovich D., Kee C., Kay I., Flexman J., Pryce T. M., Waterer G. W..( 2011;). Quantitative rt-PCR holds promise as a screening tool for patients with severe sepsis. . Emerg Med Australas 23: 502–506. [CrossRef] [PubMed]
    [Google Scholar]
  14. Koivula I., Hämäläinen S., Jantunen E., Pulkki K., Kuittinen T., Nousiainen T., Juutilainen A..( 2011;). Elevated procalcitonin predicts Gram-negative sepsis in haematological patients with febrile neutropenia. . Scand J Infect Dis 43: 471–478. [CrossRef] [PubMed]
    [Google Scholar]
  15. Kumar A., Roberts D., Wood K. E., Light B., Parrillo J. E., Sharma S., Suppes R., Feinstein D., Zanotti S. et al.( 2006;). Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. . Crit Care Med 34: 1589–1596. [CrossRef] [PubMed]
    [Google Scholar]
  16. Kweon O. J., Choi J. H., Park S. K., Park A. J..( 2014;). Usefulness of presepsin (sCD14 subtype) measurements as a new marker for the diagnosis and prediction of disease severity of sepsis in the Korean population. . J Crit Care 29: 965–970. [CrossRef] [PubMed]
    [Google Scholar]
  17. Lehmann L. E., Hunfeld K. P., Emrich T., Haberhausen G., Wissing H., Hoeft A., Stüber F..( 2008;). A multiplex real-time PCR assay for rapid detection and differentiation of 25 bacterial and fungal pathogens from whole blood samples. . Med Microbiol Immunol 197: 313–324. [CrossRef] [PubMed]
    [Google Scholar]
  18. Leli C., Cardaccia A., Ferranti M., Cesarini A., D'Alò F., Ferri C., Cenci E., Mencacci A..( 2014;). Procalcitonin better than C-reactive protein, erythrocyte sedimentation rate, and white blood cell count in predicting DNAemia in patients with sepsis. . Scand J Infect Dis 46: 745–752. [CrossRef] [PubMed]
    [Google Scholar]
  19. Liu B., Chen Y. X., Yin Q., Zhao Y. Z., Li C. S..( 2013;). Diagnostic value and prognostic evaluation of presepsin for sepsis in an emergency department. . Crit Care 17: R244. [CrossRef] [PubMed]
    [Google Scholar]
  20. Mayr F. B., Yende S., Angus D. C..( 2014;). Epidemiology of severe sepsis. . Virulence 5: 4–11. [CrossRef] [PubMed]
    [Google Scholar]
  21. Mencacci A., Leli C., Cardaccia A., Meucci M., Moretti A., D'Alò F., Farinelli S., Pagliochini R., Barcaccia M., Bistoni, F.( 2012;). Procalcitonin predicts real-time PCR results in blood samples from patients with suspected sepsis. . PLoS One 7: e53279. [CrossRef] [PubMed]
    [Google Scholar]
  22. Mongelli G., Romeo M. A., Denaro C., Gennaro M., Fraggetta F., Stefani S..( 2015;). Added value of multi-pathogen probe-based real-time PCR SeptiFast in the rapid diagnosis of bloodstream infections in patients with bacteraemia. . J Med Microbiol 64: 670–675. [CrossRef] [PubMed]
    [Google Scholar]
  23. Navarro E., Segura J. C., Castaño M. J., Solera J..( 2006;). Use of real-time quantitative polymerase chain reaction to monitor the evolution of Brucella melitensis DNA load during therapy and post-therapy follow-up in patients with brucellosis. . Clin Infect Dis 42: 1266–1273. [CrossRef] [PubMed]
    [Google Scholar]
  24. O'Neill W. J., Jordan M. H., Lewis M. S., Snider R. H., Moore C. F., Becker K. L..( 1992;). Serum calcitonin may be a marker for inhalation injury in burns. . J Burn Care Rehabil 13: 605–616. [CrossRef] [PubMed]
    [Google Scholar]
  25. Opota O., Croxatto A., Prod'hom G., Greub G..( 2015;). Blood culture-based diagnosis of bacteraemia: state of the art. . Clin Microbiol Infect 21: 313–322. [CrossRef] [PubMed]
    [Google Scholar]
  26. Oussalah A., Ferrand J., Filhine-Tresarrieu P., Aissa N., Aimone-Gastin I., Namour F., Garcia M., Lozniewski A., Guéant J. L..( 2015;). Diagnostic accuracy of procalcitonin for predicting blood culture results in patients with suspected bloodstream infection: An observational study of 35,343 consecutive patients (a strobe-compliant article). . Medicine 94: e1774. [CrossRef] [PubMed]
    [Google Scholar]
  27. Øvstebø R., Brandtzaeg P., Brusletto B., Haug K. B., Lande K., Høiby E. A., Kierulf P..( 2004;). Use of robotized DNA isolation and real-time PCR to quantify and identify close correlation between levels of Neisseria meningitidis DNA and lipopolysaccharides in plasma and cerebrospinal fluid from patients with systemic meningococcal disease. . J Clin Microbiol 42: 2980–2987. [CrossRef] [PubMed]
    [Google Scholar]
  28. Pasqualini L., Mencacci A., Leli C., Montagna P., Cardaccia A., Cenci E., Montecarlo I., Pirro M., di Filippo F. et al.( 2012;). Diagnostic performance of a multiple real-time PCR assay in patients with suspected sepsis hospitalized in an internal medicine ward. . J Clin Microbiol 50: 1285–1288. [CrossRef] [PubMed]
    [Google Scholar]
  29. Peters R. P., van Agtmael M. A., Gierveld S., Danner S. A., Groeneveld A. B., Vandenbroucke-Grauls C. M., Savelkoul P. H..( 2007;). Quantitative detection of Staphylococcus aureus and Enterococcus faecalis DNA in blood to diagnose bacteremia in patients in the intensive care unit. . J Clin Microbiol 45: 3641–3646. [CrossRef] [PubMed]
    [Google Scholar]
  30. Rabensteiner J., Skvarc M., Hoenigl M., Osredkar J., Prueller F., Reichsoellner M., Krause R., Raggam R. B..( 2014;). Diagnostic and prognostic potential of presepsin in Emergency Department patients presenting with systemic inflammatory response syndrome. . J Infect 69: 627–630. [CrossRef] [PubMed]
    [Google Scholar]
  31. Reinhart K., Bauer M., Riedemann N. C., Hartog C. S..( 2012;). New approaches to sepsis: molecular diagnostics and biomarkers. . Clin Microbiol Rev 25: 609–634. [CrossRef] [PubMed]
    [Google Scholar]
  32. Rello J., Lisboa T., Lujan M., Gallego M., Kee C., Kay I., Lopez D., Waterer G. W..DNA-Neumococo Study Group( 2009;). Severity of pneumococcal pneumonia associated with genomic bacterial load. . Chest 136: 832–840. [CrossRef] [PubMed]
    [Google Scholar]
  33. Romualdo L. G., Torrella P. E., González M. V., Sánchez R. J., Holgado A. H., Freire A. O., Acebes S. R., Otón M. D..( 2014;). Diagnostic accuracy of presepsin (soluble CD14 subtype) for prediction of bacteremia in patients with systemic inflammatory response syndrome in the Emergency Department. . Clin Biochem 47: 505–508. [CrossRef] [PubMed]
    [Google Scholar]
  34. Shozushima T., Takahashi G., Matsumoto N., Kojika M., Okamura Y., Endo S..( 2011;). Usefulness of presepsin (sCD14-ST) measurements as a marker for the diagnosis and severity of sepsis that satisfied diagnostic criteria of systemic inflammatory response syndrome. . J Infect Chemother 17: 764–769. [CrossRef] [PubMed]
    [Google Scholar]
  35. Ulla M., Pizzolato E., Lucchiari M., Loiacono M., Soardo F., Forno D., Morello F., Lupia E., Moiraghi C. et al.( 2013;). Diagnostic and prognostic value of presepsin in the management of sepsis in the emergency department: a multicenter prospective study. . Crit Care 17: R168. [CrossRef] [PubMed]
    [Google Scholar]
  36. Wanner G. A., Keel M., Steckholzer U., Beier W., Stocker R., Ertel W..( 2000;). Relationship between procalcitonin plasma levels and severity of injury, sepsis, organ failure, and mortality in injured patients. . Crit Care Med 28: 950–957. [CrossRef] [PubMed]
    [Google Scholar]
  37. Waterer G., Rello J..( 2011;). Why should we measure bacterial load when treating community-acquired pneumonia?. Curr Opin Infect Dis 24: 137–141. [CrossRef] [PubMed]
    [Google Scholar]
  38. Weinstein M. P..( 2003;). Blood culture contamination: persisting problems and partial progress. . J Clin Microbiol 41: 2275–2278. [CrossRef] [PubMed]
    [Google Scholar]
  39. Yu Z., Liu J., Sun Q., Qiu Y., Han S., Guo X..( 2010;). The accuracy of the procalcitonin test for the diagnosis of neonatal sepsis: a meta-analysis. . Scand J Infect Dis 42: 723–733. [CrossRef] [PubMed]
    [Google Scholar]
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