Contribution of Presepsin, Procalcitonin and C-reactive protein to the SOFA Score in Early Sepsis Diagnosis in Emergency Abdominal Surgical Patients
1Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, Croatia
2 Department of Anesthesiology and ICU, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, Croatia
3Children`s Hospital Srebrnjak, Srebrnjak 100, Zagreb, Croatia
DOI: 10.22514/SV151.042019.5 Vol.15,Issue 1,April 2019 pp.38-45
Published: 23 April 2019
Purpose: This study examined whether the addition of biomarkers presepsin (PSEP), procalcitonin (PCT) and C-reactive pro-tein (CRP) to the initial SOFA (iSOFA) score can improve diagnostic accuracy of early sepsis diagnosis in emergency ab-dominal 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 bio-markers) 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 mod-els 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 biomark-ers are three times more likely to have sep-sis.
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 per-formed to study the possible diagnostic value of dynamic changes of the three ex-amined markers in prediction and early diagnosis of sepsis.
Sepsis, SOFA, presepsin, procal-citonin, abdominal surgery
GORDANA FRESSL JUROŠ,MORANA TOMIČIĆ,STELLA DAVILA ŠARIĆ,MLADEN PERIĆ,DUNJA ROGIĆ. Contribution of Presepsin, Procalcitonin and C-reactive protein to the SOFA Score in Early Sepsis Diagnosis in Emergency Abdominal Surgical Patients. Signa Vitae. 2019. 15(1);38-45.
3. Havens JM, Peetz AB, Do WS, Cooper Z, Kelly E, Askari R, et al. The excess morbidity and mortality of emergency general surgery. J Trauma Acute Care Surg 2015;78(2):306–11.
4. Moore LJ, Jones SL, Xu J, Bass BL. Sepsis in general surgery: a deadly complication. Am J Surg 2009;198(6):868–74.
5. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315(8):801–10.
6. Mazuski JE, Tessier JM, May AK, Sawyer RG, Nadler EP, Rosengart MR, et al. The Surgical Infection Society Revised Guidelines on the Management of Intra-Abdominal Infection 2017;18(1):1-76
7. Moore LJ, Sepsis in General Surgery. Arch Surg 2010;145(7):695.
8. Yang Y, Xie J, Guo F, Longhini F, Gao Z, Huang Y, et al. Combination of C-reactive protein, procalcitonin and sepsis-related organ failure score for the diagnosis of sepsis in critical patients. Ann Intensive Care 2016;6(1):51.
9. Sequential Organ Failure Assessment (SOFA) Calculator - ClinCalc.com.
10. Pierrakos C, Vincent J-L. Sepsis biomarkers: a review. Crit Care 2010;14(1):R15.
11. Dellinger RP, Schorr CA, Levy MM. A user`s guide to the 2016 Surviving Sepsis Guidelines. Intensive Care Med2017;43(3):299-303..
12. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med 2017;43(3) :304-377.
13. Vodnik T, Kaljevic G, Tadic T, Majkic-Singh N. Presepsin (sCD14-ST) in preoperative diagnosis of abdominal sepsis. Clin Chem Lab Med 2013;51(10):2053–62.
14. Yaegashi Y, Sato N, Suzuki Y, Kojika M, Imai S, Takahashi G, et al. Evaluation of a newly identified soluble CD14 subtype as a marker for sepsis. J Infect Chemother 2005;11(5):234–8.
15. Zhang X, Liu D, Liu Y-N, Wang R, Xie L-X. The accuracy of presepsin (sCD14-ST) for the diagnosis of sepsis in adults: a meta-analysis. Crit Care 2015;19:323.
16. Pupelis G, Drozdova N, Mukans M, Malbrain ML. Serum procalcitonin is a sensitive marker for septic shock and mortality in sec-ondary peritonitis. Anestezjol Intens Ter 2014;46(4):262–73.
17. Ravishankaran P, Shah AM, Bhat R. Correlation of Interleukin-6, Serum Lactate, and C-Reactive Protein to inflammation, complica-tion, and outcome during the surgical course of patients with acute abdomen. J Interf Cytokine Res 2011;31(9):685–90.
18. Domínguez-Comesaña E, López-Gómez V, Estevez-Fernández SM, Mariño Padín E, Ballinas-Miranda J, Carrera-Dacosta E, et al. Procalcitonin and C-Reactive Protein as early indicators of iostoperative intra-abdominal infection after surgery for gastrointestinal cancer. Cirugía Española 2014;92(4):240–6.
19. Santonocito C, De Loecker I, Donadello K, Moussa MD, Markowicz S, Gullo A, et al. C-reactive protein kinetics after major surgery. Anesth Analg 2014;119(3):624–9.
20. Wu J, Hu L, Zhang G, Wu F, He T. Accuracy of presepsin in sepsis diagnosis: a systematic review and meta-analysis. Groeneveld ABJ, editor. PLoS One 2015;10(7):e0133057.
21. Gans SL, Atema JJ, Van Dieren S, Bas &, Koerkamp G, Boermeester MA. Diagnostic value of C-reactive protein to rule out infectious complications after major abdominal surgery: a systematic review and meta-analysis 2015;30(7)851-73
22. Giavarina D, Carta M. Determination of reference interval for presepsin, an early marker for sepsis. Biochem medica 2015;25(1):64–8.
23. Shozushima T, Takahashi G, Matsumoto N, Kojika M, Okamura Y, Endo S. 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 2011;17(6):764–9.
24. Riedel S, Melendez JH, An AT, Rosenbaum JE, Zenilman JM. Procalcitonin as a marker for the detection of bacteremia and sepsis in the emergency department. Am J Clin Pathol 2011;135(2):182–9.
25. Meyer ZC, Schreinemakers JMJ, Mulder PGH, de Waal RAL, Ermens AAM, van der Laan L. The role of C-Reactive Protein and the SOFA Score as parameter for clinical decision making in surgical patients during the intensive care unit course. Salluh JIF, editor. PLoS One 2013;8(2):e55964.
26. Papp M, Tornai T, Vitalis Z, Tornai I, Tornai D, Dinya T, et al. Presepsin teardown - pitfalls of biomarkers in the diagnosis and prog-nosis of bacterial infection in cirrhosis. World J Gastroenterol 2016;22(41):9172–85.
27. Kotera A, Sagishima K, Tashiro T, Niimori D, Kamohara H, Kinoshita Y. A validation of presepsin levels in kidney dysfunction pa-tients: four case reports. J Intensive Care 2014;2(1):63.
28. Nagata T, Yasuda Y, Ando M, Abe T, Katsuno T, Kato S, et al. Clinical impact of kidney function on presepsin levels. PLoS One 2015;10(6):e0129159.
29. Masson S, Caironi P, Fanizza C, Thomae R, Bernasconi R, Noto A, et al. Circulating presepsin (soluble CD14 subtype) as a marker of host response in patients with severe sepsis or septic shock: data from the multicenter, randomized ALBIOS trial. Intensive Care Med 2015;41(1):12–20.
30. Lacoma A, Prat C, Andreo F, Lores L, Ruiz-Manzano J, Ausina V, et al. Value of procalcitonin, C-reactive protein, and neopterin in exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2011;6:157–69.
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