title: Diagnostic accuracy of presepsin (soluble CD14 subtype) for prediction of bacteremia in patients with systemic inflammatory response syndrome in the Emergency Department.
abstract: BACKGROUND
  Bacteremia is indicative of severe bacterial infection with significant mortality. Its early diagnosis is extremely important for implementation of antimicrobial therapy but a diagnostic challenge. Although blood culture is the "gold standard" for diagnosis of bacteremia this method has limited usefulness for the early detection of blood-stream infection. In this study we assessed the presepsin as predictor of bacteremia in patients with systemic inflammatory response syndrome (SIRS) on admission to the Emergency Department and compare it with current available infection biomarkers.
  
  
  METHODS
  A total of 226 patients admitted to the Emergency Department with SIRS were included. In 37 patients blood culture had a positive result (bacteremic SIRS group) and 189 had a negative blood culture result (non-bacteremic SIRS group). Simultaneously with blood culture, presepsin, procalcitonin (PCT) and C-reactive protein (CRP) were measured. Receiver operating characteristic (ROC) curve analysis was performed for each biomarker as predictor of bacteremia.
  
  
  RESULTS
  Presepsin values were significantly higher in bacteremic SIRS group when compared with non-bacteremic SIRS group. ROC curve analysis and area under curve (AUC) revealed a value of 0.750 for presepsin in differentiating SIRS patients with bacteremia from those without, similar than that for PCT (0.787) and higher than that for CRP (0.602). The best cut-off value for presepsin was 729pg/mL, which was associated with a negative predictive value of 94.4%.
  
  
  CONCLUSIONS
  Presepsin may contribute to rule out the diagnosis of bacteremia in SIRS patients admitted to the Emergency Department.
authors.affiliation: Biochemistry Department, University Hospital Santa Lucía, Spain. Electronic address: guadianarom@yahoo.es.
authors.forename: Luis García de Guadiana
authors.initials: LG
authors.lastname: Romualdo
authors.affiliation: Biochemistry Department, University Hospital Santa Lucía, Spain.
authors.forename: Patricia Esteban
authors.initials: PE
authors.lastname: Torrella
authors.affiliation: Microbiology Department, University Hospital Santa Lucía, Spain.
authors.forename: Monserrat Viqueira
authors.initials: MV
authors.lastname: González
authors.affiliation: Critical Care Unit, University Hospital Santa Lucía, Spain.
authors.forename: Roberto Jiménez
authors.initials: RJ
authors.lastname: Sánchez
authors.affiliation: Biochemistry Department, University Hospital Santa Lucía, Spain.
authors.forename: Ana Hernando
authors.initials: AH
authors.lastname: Holgado
authors.affiliation: Critical Care Unit, University Hospital Santa Lucía, Spain.
authors.forename: Alejandro Ortín
authors.initials: AO
authors.lastname: Freire
authors.affiliation: Critical Care Unit, University Hospital Santa Lucía, Spain.
authors.forename: Sergio Rebollo
authors.initials: SR
authors.lastname: Acebes
authors.affiliation: Biochemistry Department, University Hospital Santa Lucía, Spain.
authors.forename: María Dolores Albaladejo
authors.initials: MD
authors.lastname: Otón
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D016470:Bacteremia / Q000175:diagnosis* / Q000276:immunology* / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D018950:Lipopolysaccharide Receptors / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D018746:Systemic Inflammatory Response Syndrome / Q000276:immunology* / Q000378:metabolism*
chemical_list: D018950:Lipopolysaccharide Receptors; D002097:C-Reactive Protein
keywords: Bacteremia; C-reactive protein; Diagnostic accuracy; Emergency Department; Presepsin; Procalcitonin; SIRS