title: Prognostic value of presepsin for outcomes and complications in enterocutaneous fistula complicated by abdominal sepsis.
abstract: BACKGROUND
  Enterocutaneous fistula (ECF) poses a supreme challenge for the surgeons associated with abdominal sepsis, fluid electrolyte imbalance and undernutrition. Individual prognostic stratification is pivotal in the clinical management. Presepsin is a novel biomarker showing diagnostic and prognostic value in sepsis. We aimed to evaluate the prognostic value of presepsin in ECF.
  
  
  METHODS
  Consecutive patients with ECF were enrolled if diagnosed as abdominal sepsis from June 2014 to June 2015. Serum concentration of presepsin at admission was measured, and medical records including demographics, medical history, treatment modalities, complications and outcomes were collected. Kaplan-Meier curves was drawn to demonstrate the cumulative incidence of source control of infection and fistula closure, and Cox regression analysis was performed to identify independent factors. Association between presepsin and other markers was evaluated by Pearson's correlation coefficient.
  
  
  RESULTS
  71 patients were included with the median presepsin concentration of 726 pg/mL at admission. Baseline presepsin levels showed predictive potential in successful source control of intra-abdominal infection but not in fistula closure. Patients with higher presepsin had more severe intra-abdominal infection as denoted by higher levels of WBC, CRP and PCT, as well as high risks of complications and failure of fistula closure compared with those having lower presepsin (≤726 pg/mL). Presepsin concentration was positively associated with APACHE II score, CRP and PCT.
  
  
  CONCLUSIONS
  Presepsin shows prognostic values for source control of abdominal sepsis and clinical courses of ECF. This index may help stratify patients, facilitating the monitoring and adjustment of the therapeutic regimen at an early stage.
authors: Department of General Surgery, The People's Hospital of Zhengzhou University (Henan Provincial People's Hospital), Zhengzhou, 450003, China. Electronic address: 573788718@qq.com.
authors: Xiaofei
authors: X
authors: Song
authors: Department of General Surgery, The People's Hospital of Zhengzhou University (Henan Provincial People's Hospital), Zhengzhou, 450003, China. Electronic address: yucheng_s@sina.cn.
authors: Yucheng
authors: Y
authors: Song
authors: Department of General Surgery, The People's Hospital of Zhengzhou University (Henan Provincial People's Hospital), Zhengzhou, 450003, China. Electronic address: yuan_y168@sina.com.
authors: Yuan
authors: Y
authors: Yuan
authors: Department of General Surgery, The People's Hospital of Zhengzhou University (Henan Provincial People's Hospital), Zhengzhou, 450003, China. Electronic address: peng_z123@sina.com.
authors: Peng
authors: P
authors: Zhang
authors: Department of General Surgery, The People's Hospital of Zhengzhou University (Henan Provincial People's Hospital), Zhengzhou, 450003, China. Electronic address: xuedong_z@sina.com.
authors: Xuedong
authors: X
authors: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007412:Intestinal Fistula / Q000097:blood* / Q000150:complications*; D059413:Intraabdominal Infections / Q000175:diagnosis* / Q000453:epidemiology; D018950:Lipopolysaccharide Receptors / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D018805:Sepsis / Q000175:diagnosis* / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D018950:Lipopolysaccharide Receptors; D010446:Peptide Fragments; C000594167:presepsin protein, human
keywords: Abdominal sepsis; Enterocutaneous fistula; Presepsin; Prognosis