Serum Presepsin (Soluble Cd14-St) Levels in Patients with Systemic Inflammatory Response Syndrome and Sepsis: A Comparison with The Sepsis-3 Reclassification

Abstract

Background: Pediatric sepsis and systemic inflammatory response syndrome are clinical entities associated with high morbidity and mortality, for which early diagnosis and risk stratification are difficult. This study aimed to investigate the diagnostic value of presepsin, procalcitonin, C-reactive protein and leukocyte count in pediatric systemic inflammatory response syndrome and sepsis. Methods: This prospective study initially enrolled 21 systemic inflammatory response syndrome (SIRS) patients, 25 sepsis patients and 40 healthy controls aged 1 month–18 years in 2015, classified according to the 2001 International Sepsis Definitions Conference criteria. To address current methodological standards, all patient-group subjects were subsequently reclassified according to the Sepsis-3 consensus definitions; 34 patients met Sepsis-3 criteria and 40 healthy controls were retained. Systemic inflammatory response syndrome and sepsis were defined according to the criteria of the 2001 International Sepsis Definitions Conference. Results: Leukocyte, C-reactive protein, procalcitonin and presepsin levels were significantly higher in both the systemic inflammatory response syndrome and sepsis groups than in controls (all p<0.001). Under the Sepsis-3 reclassification (sepsis, n=34 vs. controls, n=40), all four biomarkers remained significantly elevated in the sepsis group (all p<0.001), with presepsin and procalcitonin achieving the highest diagnostic performance (AUC 0.976 each). In distinguishing patient groups from controls, procalcitonin and presepsin showed high sensitivity and specificity with strong diagnostic performance. However, diagnostic power was more limited for differentiating systemic inflammatory response syndrome from sepsis under the 2001 criteria. Conclusions: In pediatric systemic inflammatory response syndrome and sepsis, leukocyte count, C-reactive protein, procalcitonin and presepsin are sensitive indicators of systemic inflammatory response. Procalcitonin and presepsin are strong markers for distinguishing patient groups from healthy controls under both the 2001 SCCM criteria and the Sepsis-3 reclassification; however, because the performance of individual biomarkers in differentiating systemic inflammatory response syndrome from sepsis is limited, multimarker diagnostic algorithms are needed.

Keywords

• C-reactive protein
• Procalcitonin
• Sepsis
• SIRS
• soluble CD14-ST.

Supporting Institution

The study was additionally supported by the Kahramanmaraş University Scientific Research Projects Coordination Unit (project no: 2015/1 82D).

Project Number

The study was additionally supported by the Kahramanmaraş University Scientific Research Projects Coordination Unit (project no: 2015/1 82D).

Ethical Statement

The study was carried out prospectively at the Department of Paediatrics, Kahramanmaraş University Faculty of Medicine, over the period from 1 January to 15 December 2015. Ethical approval was obtained from the the local ethics committee on 09 March 2015 (decision no: 2015/04-07).

Sistemik İnflamatuvar Yanıt Sendromu ve Sepsisli Hastalarda Serum Presepsin (Soluble Cd14-St) Düzeyleri: Sepsis-3 Yeniden Sınıflandırması ile Karşılaştırma

Abstract

Giriş: Pediatrik sepsis ve sistemik inflamatuar yanıt sendromu, yüksek morbidite ve mortalite ile ilişkili klinik tablolardır ve bu durumlarda erken tanı ve risk sınıflandırması zordur. Bu çalışmanın amacı, pediatrik sistemik inflamatuar yanıt sendromu ve sepsiste presepsin, prokalcitonin, C-reaktif protein ve lökosit sayısının tanısal değerini araştırmaktı. Yöntemler: Bu prospektif çalışmaya, 2015 yılında, 2001 Uluslararası Sepsis Tanımları Konferansı kriterlerine göre sınıflandırılmış, 1 ay–18 yaş arası 21 sistemik inflamatuar yanıt sendromu (SIRS) hastası, 25 sepsis hastası ve 40 sağlıklı kontrol ilk olarak dahil edilmiştir. Mevcut metodolojik standartlara uymak amacıyla, tüm hasta grubu denekleri daha sonra Sepsis-3 konsensüs tanımlarına göre yeniden sınıflandırılmıştır; 34 hasta Sepsis-3 kriterlerini karşılamış ve 40 sağlıklı kontrol deneği çalışmada tutulmuştur. Sistemik inflamatuar yanıt sendromu ve sepsis, 2001 Uluslararası Sepsis Tanımları Konferansı kriterlerine göre tanımlanmıştır. Bulgular: Lökosit, C-reaktif protein, prokalcitonin ve presepsin düzeyleri, hem sistemik inflamatuar yanıt sendromu hem de sepsis gruplarında kontrol grubuna göre anlamlı olarak daha yüksekti (tümü p<0,001). Sepsis-3 yeniden sınıflandırmasına göre (sepsis, n=34 vs. kontrol grubu, n=40), dört biyobelirteç de sepsis grubunda anlamlı olarak yüksek kaldı (tümü p<0,001); presepsin ve prokalcitonin en yüksek tanısal performansa ulaştı (her biri için AUC 0,976). Hasta gruplarını kontrol grubundan ayırt etmede, prokalcitonin ve presepsin, güçlü tanısal performansla yüksek duyarlılık ve özgüllük göstermiştir. Ancak, 2001 kriterleri altında sistemik inflamatuar yanıt sendromunu sepsisten ayırt etmede tanısal güç daha sınırlıydı. Sonuç: Pediatrik sistemik inflamatuar yanıt sendromu ve sepsiste, lökosit sayısı, C-reaktif protein, prokalcitonin ve presepsin, sistemik inflamatuar yanıtın duyarlı göstergeleridir. Prokalsitonin ve presepsin, hem 2001 SCCM kriterleri hem de Sepsis-3 yeniden sınıflandırması kapsamında hasta gruplarını sağlıklı kontrol grubundan ayırt etmek için güçlü belirteçlerdir; ancak, sistemik inflamatuar yanıt sendromunu sepsisten ayırt etmede tek tek biyobelirteçlerin performansı sınırlı olduğundan, çoklu belirteçli tanısal algoritmalara ihtiyaç vardır.

Keywords

• C-reaktif protein
• Prokalsitonin
• Sepsis
• SIRS
• soluble CD14-ST.

Supporting Institution

The study was additionally supported by the Kahramanmaraş University Scientific Research Projects Coordination Unit (project no: 2015/1 82D).

Project Number

The study was additionally supported by the Kahramanmaraş University Scientific Research Projects Coordination Unit (project no: 2015/1 82D).

Ethical Statement

The study was carried out prospectively at the Department of Paediatrics, Kahramanmaraş University Faculty of Medicine, over the period from 1 January to 15 December 2015. Ethical approval was obtained from the the local ethics committee on 09 March 2015 (decision no: 2015/04-07).

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