Role of plasma bactericidal/permeability-increasing protein, group IIA phospholipase A(2), C-reactive protein, and white blood cell count in the early detection of severe sepsis in the emergency department.
OBJECTIVE
To study the diagnostic values of bactericidal/permeability-increasing protein (BPI), group IIA phospholipase A(2) (PLA(2)GIIA), white blood cell count (WBC), and C-reactive protein (CRP) in identifying severe sepsis upon admission in an emergency room.


METHODS
This was a single-centre prospective cohort study involving 525 adult patients admitted to the emergency room with suspected infection. Plasma samples were taken concurrently with the blood cultures. Forty-nine patients with severe sepsis and 476 other patients (58 with no systemic inflammatory response syndrome (SIRS) and no bacterial infection, 63 with bacterial infection but no SIRS, 53 with SIRS but no bacterial infection, and 302 with sepsis but no organ dysfunction) were evaluated. BPI and PLA(2)GIIA were measured by time-resolved fluoroimmunoassay, and CRP with an immunoturbidimetric assay. WBC was measured using an automatic cell counter.


RESULTS
There was a positive correlation between the plasma levels of PLA(2)GIIA and CRP (Pearson's correlation coefficient 0.60, p < 0.001). On logistic regression analysis the odds ratio (OR) (95% confidence limits (95% Cl)) for BPI was 2.66 (1.54-4.60, p = 0.001), for PLA(2)GIIA 1.48 (1.20-1.81, p < 0.001), for CRP 1.35 (1.02-1.77, p = 0.036), and for WBC 2.81 (1.48-5.34, p = 0.002). The differences in area under the receiver operator characteristic curve (AUC) between these parameters were not significant. On multivariate logistic regression analysis only PLA(2)GIIA could differentiate patients with severe sepsis from others (OR 1.37, 95% Cl 1.05-1.78, p = 0.019). After adjusting for confounders PLA(2)GIIA remained a significant independent predictor of severe sepsis.


CONCLUSIONS
PLA(2)GIIA seemed to be superior to CRP, BPI, and WBC in differentiating patients with severe sepsis. BPI gave no additional information in this respect.
Department of Infectious Diseases, Satakunta Central Hospital, Pori, Finland. raija.uusitalo-seppala@satadiag.fi
Raija
R
Uusitalo-Seppälä
Heikki
H
Peuravuori
Pertti
P
Koskinen
Tero
T
Vahlberg
Esa M
EM
Rintala
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D023181:Antimicrobial Cationic Peptides / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001798:Blood Proteins; D002097:C-Reactive Protein / Q000378:metabolism*; D004636:Emergency Service, Hospital; D005260:Female; D054501:Group II Phospholipases A2 / Q000097:blood*; D006801:Humans; D007958:Leukocyte Count; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012372:ROC Curve; D018805:Sepsis / Q000097:blood* / Q000175:diagnosis / Q000201:enzymology
D023181:Antimicrobial Cationic Peptides; D015415:Biomarkers; D001798:Blood Proteins; C021623:bactericidal permeability increasing protein; D002097:C-Reactive Protein; D054501:Group II Phospholipases A2; C516287:PLA2G2A protein, human