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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Contribution of Presepsin, Procalcitonin and C-reactive protein to the SOFA Score in Early Sepsis Diagnosis in Emergency Abdominal Surgical Patients

Abstract

Purpose: This study examined whether the addition of biomarkers presepsin (PSEP), procalcitonin (PCT) and C-reactive protein (CRP) to the initial SOFA (iSOFA) score can improve diagnostic accuracy of early sepsis diagnosis in emergency abdominal surgery patients.

Materials and Methods: Seventy-two study subjects had diagnosis of acute abdomen due to gastrointestinal disturbances. The study evaluated diagnostic accuracy and predictive value of two models (iSOFA only and iSOFA combined with three biomarkers) for sepsis diagnosis.

Results: The AUC value for the iSOFA was highest, followed by the AUC value obtained for PSEP, PCT and CRP (0.989, 0.738, 0.694 and 0.606, respectively).The logistic regression analysis of the two models showed for the first model that patients with a higher iSOFA score are almost two times more likely to suffer from sepsis. In the second model, patients with a higher iSOFA score and a higher level of biomarkers are three times more likely to have sepsis.

Conclusions: Although the SOFA score is known to be the best diagnostic tool for sepsis diagnosis, it seems that among the three investigated markers PSEP and PCT– although not contributing to the iSOFA score– are good independent markers with significantly higher levels in septic than in non-septic patients. PSEP has the highest diagnostic accuracy for sepsis. Only the conventional marker CRP provides certain added value to the iSOFA score for sepsis prediction.

Further investigations should be performed to study the possible diagnostic value of dynamic changes of the three examined markers in prediction and early diagnosis of sepsis.

Keywords: Sepsis, SOFA, presepsin, procalcitonin, abdominal surgery

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Biomarkers of sepsis in neonates and children

Abstract

Sepsis, and related complications, is still a common cause of death in hospitalized patients worldwide, especially in critically ill neonates and children. Sepsis is also responsible for significant morbidity, and financial burden. It is very important to recognize sepsis early, since delayed diagnosis is associated with worse outcome. The early detection of sepsis remains a great challenge for clinicians because the use of blood cultures, the gold standard for diagnosis of bacteremia, is fraught with difficulties. The role of different immune and metabolic biomarkers is to improve the diagnosis, treatment and prognosis of sepsis. White blood cell count, C-reactive protein and procalcitonin are currently the most widely used biomarkers, but they have limited abilities to distinguish sepsis from other inflammatory conditions or to predict outcome. In this review, these biomarkers will be discussed along with novel diagnostic, prognostic and treatment response biomarkers, including interleukins -6, -8, -18, tumor necrosis factor – alpha, CD11b, CD64 and CD15s. The future of sepsis biomarkers lies in extensive validation studies of all novel biomarkers and their combinations as early predictors of sepsis. Also, research to identify novel sepsis biomarkers and develop specific therapeutic strategies based on biomarker information has to be continued.

Key words: infant, child, biomarkers, CD15s antigen, C-reactive protein, procalcitonin

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Procalcitonin – potential, limitations and availability

Abstract

Bacterial infections and sepsis are major problems in critically ill patients. Timely diagnosis and therapy reduce morbidity and mortality. Many studies have included the investigation of various biomarkers whose elevated concentrations can indicate sepsis; among them, PCT proved to be most useful.

PCT is synthesized in the thyroid gland as a prohormone of calcitonin. In healthy individuals the PCT concentration is <0.1 ng/mL.

The advantage of the PCT is a high negative predictive value for the exclusion of sepsis, with the cut-off value of 0.5 ng/ml. A concentration between 2 and 10 ng/ml indicates strong sepsis, whereas a value ≥10 ng/ml is associated with septic shock. In addition to the diagnosis of sepsis, the measurement of PCT concentration is useful for the introduction and monitoring of antibiotic therapy, which is performed according to an algorithm based on the cut-off value for PCT.

Immunoassays are used to measure PCT concentrations in serum or plasma. It is possible to determine the concentration in whole blood by using point-of-care testing.

In pathological conditions that are not associated with sepsis, PCT is useful as a prognostic indicator of disease complications. Some studies suggest that PCT is a potential early indicator of acute coronary syndrome.

Key words: procalcitonin, bacterial infection, sepsis, intensive care unit

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