Sepsis biomarkers dynamics as an indicator of intensive care effectiveness

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Aim — to evaluate dynamics of presepsin, procalcitonin and C-reactive protein in survived and dead patients with sepsis. Material and methods. There were 41 patients with diagnosis of «sepsis» («Sepsis-3» concept) who were divided into 2 groups: survived patients with sepsis (21 people) — group 1, dead patients with sepsis (20 people) — group 2. All patients underwent generally accepted intensive therapy for sepsis. Besides conventional laboratory and instrumental examination, dynamics of presepsin, procalcitonin and C-reactive protein was assessed. Results. Mean level of presepsin was 1718.00 and 3266.50 pg/ml in groups 1 and group 2, respectively. Half of the values was within (Me (25; 75) 1021.00—3231.00 pg/ml and 1618.50—7469.00 pg/ml in both groups, respectively. Mean level of procalcitonin was 0.995 and 4.465 ng/ml, respectively. Median (25; 75) was 0.49—4.44 ng/ml and 1,625—19.30 ng/ml, respectively. Mean level of C-reactive protein was 95.5 and 215.0 mg/L, respectively, median (25; 75) — 64.00—155.00 mg/L and 155.00—264.00 mg/L, respectively. Significant differences were determined for all variables (p-value 0.000008, 0.000242, 0.0000001 for presepsin, procalcitonin and C-reactive protein, respectively). Conclusion. The levels of C-reactive protein, procalcitonin and presepsin were significantly different in patients with sepsis followed by favorable and unfavorable clinical outcome. Unfavorable outcome was associated with increased levels of all biomarkers. Comprehensive assessment of all biological markers of sepsis is useful to assess an effectiveness of intensive therapy and to predict clinical outcome.

Keywords:

sepsis biomarkers

intensive care

Authors:

Zviagin A.A.

Institut khirurgii im. A.V. Vishnevskogo Ministerstva zdravookhraneniia i sotsial'nogo razvitiia RF, Moskva

Demidova V.S.

Otdelenie khirurgii sosudov Instituta khirurgii im. A.V. Vishnevskogo, Moskva

Smirnov G.V.

Vishnevsky National Medical Research Center for Surgery of Healthcare Ministry of Russia, Moscow, Russia

List of references:

Qi Zou, Wei Wen, and Xin-chao Zhang. Presepsin as a novel sepsis biomarker. World J Emerg Med. 2014;5(1):16-19. https://doi.org/10.5847/wjem.j.issn.1920-8642.2014.01.002
Jawad I, Luksic I, Rafnsson SB. Assessing available information on the burden of sepsis: global estimates of incidence, prevalence and mortality. J Global Health. 2012;2:1-9. https://doi.org/10.7189/jogh.01.010404
Martin GS. Sepsis, severe sepsis and septic shock: changes in incidence, pathogens and outcomes. Expert Rev Anti-Infect Ther. 2012;10:701-706. https://doi.org/10.1586/eri.12.50
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, Poll T, Vincent JL, Angus DC. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8). https://doi.org/10.1001/jama.2016.0287
Fan SL, Miller NS, Lee J, Remick DG. Diagnosing sepsis: the role of laboratory medicine. Clin Chim Acta. 2016;460:203-210. https://doi.org/10.1016/j.cca.2016.07.002
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A, Sevransky JE, Sprung CL, Nunnally ME, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2017;45(3):486-552. https://doi.org/10.1097/CCM.0000000000002255
De Jong E, van Oers JA, Beishuizen A, Vos P, Vermeijden WJ, Haas LE, et al. Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: a randomised, controlled, open-label trial. Lancet Infect Dis. 2016;16:819-827. https://doi.org/10.1016/S1473-3099(16)00053-0
Ali FT, Ali MA, Elnakeeb MM, Bendary HN. Presepsin is an early monitoring biomarker for predicting clinical outcome in patients with sepsis. Clin Chim Acta. 2016;460:93-101. https://doi.org/10.1016/j/cca.2016.06.030
Behnes M, Bertsch T, Lepiorz D, Lang S, Trinkmann F, Brueckmann M, et al. Diagnostic and prognostic utility of soluble CD 14 subtype (presepsin) for severe sepsis and septic shock during the first week of intensive care treatment. Crit Care. 2014;18:507. https://doi.org/10.1186/s13054-014-0507-z
Klouche K, Cristol JP, Devin J, Gilles V, Kuster N, Larcher R, et al. Diagnostic and prognostic value of soluble CD14 subtype (Presepsin) for sepsis and community-acquired pneumonia in ICU patients. Ann Intensive Care. 2016;6:59. https://doi.org/10.1186/s13613-016-0160-6
Julian-Jimenez A, Candel-Gonzalez FJ, Gonzalez Del Castillo J. Usefulness of inflammation and infection biomarkers in the Emergency Department. Enferm Infecc Microbiol Clin. 2014;32(3):177-190. https://doi.org/10.1016/j.eimc.2013.01.005
Cakir Madenci O, Yakupoglu S, Benzonana N, Yucel N, Akbaba D, Orcun Kaptanagasi A. Evaluation of soluble CD14 subtype (presepsin) in burn sepsis. Burns. 2014;40(4):664-669. https://doi.org/10.1016/j.burns.2013.08.024
Carpio R, Zapata J, Spanuth E, Hess G. Utility of presepsin (sCD14-ST) as a diagnostic and prognostic marker of sepsis in the emergency department. Clin Chim Acta. 2015;450:169-175. https://doi.org/10.1016/j.cca.2015.08.013
Endo S, Suzuki Y, Takahashi G, Shozushima T, Ishikura H, Murai A, Nishida T, Irie Y, Miura M, Iguchi H, et al. Usefulness of presepsin in the diagnosis of sepsis in a multicenter prospective study. J Infect Chemother. 2012;18(6):891-897. https://doi.org/10.1007/s10156-012-0435-2
Godnic M, Stubljar D, Skvarc M, Jukic T. Diagnostic and prognostic value of sCD14-ST-presepsin for patients admitted to hospital intensive care unit (ICU). Wien Klin Wochenschr. 2015;127(13-14):521-527. https://doi.org/10.1007/s00508-015-0793-8
Ishikura H, Nishida T, Murai A, Nakamura Y, Irie Y, Tanaka J, Umemura T. New diagnostic strategy for sepsis-induced disseminated intravascular coagulation: a prospective single-center observational study. Crit Care. 2014;18(1):R19. https://doi.org/10.1186/cc13700
Kweon OJ, Choi JH, Park SK, Park AJ. 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. 2014;29(6):965-970. https://doi.org/10.1016/j.jcrc.2014.06.014
Liu B, Chen YX, Yin Q, Zhao YZ, Li CS. Diagnostic value and prognostic evaluation of Presepsin for sepsis in an emergency department. Crit Care. 2013;17(5):R244. https://doi.org/10.1186/cc13070
Sepsis: klassifikatsiya, kliniko-diagnosticheskaya kontseptsiya i lechenie. Pod redaktsiei akad. RAN Gel’fanda BR. M.: MIA; 2017;351. (In Russ.)
Velkov VV. Presepsin — new highly effective sepsis biomarker. Kliniko-laboratornyi konsilium. Nauchno-prakticheskii zhurnal. 2012;2(42):56-62. (In Russ.)
Demidova VS, Ushakova TA, Zvyagin AA, Bobrovnikov AE, Medova OV, Koryakov IA. The clinical significance of presepsine in infectious complications in patients with surgical infection and burn trauma. Infektsii v khirurgii. 2014;4:44-46. (In Russ.)
Gel’fand BR, Protsenko DN, Gel’fand EB, Yaroshetskii AI. Sepsis: patogenez i sovremennye metody intensivnoi terapii. Rukovodstvo po ekstrakorporal’nomu ochishcheniyu krovi v intensivnoi terapii. M. 2009;273-299 (In Russ.)
Gel’fand BR, Burnevich SZ, Gel’fand EB, Brazhnik TB, Sergeeva NA. Biokhimicheskie markery sistemnoi vospalitelnoy reaktsii: rol’ prokal;tsitonina v diagnostike sepsisa. Infektsii v khirurgii. 2007;5(1):17-24. (In Russ.)
Velkov VV. Procalcitonin and c-reactive protein in modern laboratory diagnostics. Part 2. Kliniko-laboratornyi konsilium. Nauchno-prakticheskii zhurnal. 2009:34-38. (In Russ.)
Vodnik T, Kaljevic G, Tadic T, Majkic-Singh N. Presepsin (sCD14-ST) in preoperative diagnosis of abdominal sepsis. Clin Chem Lab Med. 2013;51:2053-2062. https://doi.org/10.1515/cclm-2013-0061

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