Presepsin in the prognosis of infectious diseases and diagnosis of infectious disseminated intravascular coagulation: a prospective, multicentre, observational study.
BACKGROUND
Few prospective studies have described the prognostic accuracy of presepsin for 28-day mortality during days 0 to 7, or its role in the diagnosis of disseminated intravascular coagulation (DIC) in patients with infection.


OBJECTIVE
We aimed to evaluate the clinical usefulness of presepsin levels by comparing infection markers such as procalcitonin, interleukin-6 and C-reactive protein, as well as markers of DIC such as fibrin degradation products (FDPs) and D-dimer, from days 0 to 7.


METHODS
A prospective, multicentre, observational study.


METHODS
Four medical institutions between June 2010 and June 2011.


METHODS
A total of 191 patients who fulfilled at least one of the systemic inflammatory response syndrome (SIRS) criteria were enrolled in the study.


METHODS
The presepsin levels were evaluated for their diagnostic accuracy in discriminating between SIRS and sepsis, the prognostic accuracy for 28-day mortality from days 0 to 7 and the diagnostic accuracy for DIC in patients with infection by comparison with other infection markers.


RESULTS
The diagnostic accuracy for discriminating between SIRS and sepsis from combining the presepsin and procalcitonin measurements [area under the curve (AUC), 0.91; likelihood ratio, 4.96] was higher than that of presepsin (AUC, 0.89; likelihood ratio, 4.75) or procalcitonin (AUC, 0.85; likelihood ratio, 3.18) alone. Not only the correlation coefficient between the presepsin level and the sequential organ failure assessment (SOFA) score but also the prognostic accuracy of presepsin for 28-day mortality increased with the elapsed time, and both were highest at day 7. The diagnostic accuracy for DIC generated by combining presepsin and FDP (AUC, 0.84; likelihood ratio, 3.57) was higher than that of FDP (AUC, 0.82; likelihood ratio, 2.64) or presepsin (AUC, 0.80; likelihood ratio, 2.94) alone.


CONCLUSIONS
The prognosis and severity of infection may be assessed more accurately by measuring the presepsin levels until day 7. Presepsin is a useful diagnostic tool for DIC with infection.
From the Department of Critical Care Medicine, Iwate Medical University, Morioka (GT, SS, YI, SE), Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, Fukuoka (HI), Anesthesiology, Emergency and Critical Care Center, Kariya Toyota General Hospital, Kariya (MM) and Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan (YF).
Gaku
G
Takahashi
Shigehiro
S
Shibata
Hiroyasu
H
Ishikura
Masanao
M
Miura
Yasuo
Y
Fukui
Yoshihiro
Y
Inoue
Shigeatsu
S
Endo
D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D003141:Communicable Diseases / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D003937:Diagnosis, Differential; D004211:Disseminated Intravascular Coagulation / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007564:Japan; D016013:Likelihood Functions; D018950:Lipopolysaccharide Receptors / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018805:Sepsis / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D012772:Shock, Septic / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D013997:Time Factors
D015415:Biomarkers; D018836:Inflammation Mediators; D018950:Lipopolysaccharide Receptors; D010446:Peptide Fragments; C000594167:presepsin protein, human