Pancreatic stone protein and soluble CD25 for infection and sepsis in an emergency department.
BACKGROUND
Infection is a common problem in emergency departments (EDs) and is associated with high mortality, morbidity and costs. Identifying infection in ED patients can be challenging. Biomarkers can facilitate its diagnosis, enabling an early management and improving outcomes. In the critical care setting, two emerging biomarkers, pancreatic stone protein (PSP) and soluble CD25 (sCD25), have demonstrated to be useful for diagnosis of sepsis. We aimed to assess the diagnostic value of these biomarkers, in comparison with procalcitonin (PCT), for infection and sepsis in an ED population with suspected infection.


METHODS
Through a prospective, observational study, we investigated the utility of serum PCT, PSP and sCD25 levels, measured on admission, for diagnosis of infection and sepsis, defined according to the recently updated for sepsis (Sepsis-3), in patients presenting to the ED for suspected infection. Diagnostic accuracy was evaluated by using receiver operating characteristic curves (ROC) analysis.


RESULTS
Of the 152 patients enrolled in this study, 129 had a final diagnosis of infection, including 82 with noncomplicated infection and 47 with sepsis. Median PCT, PSP and sCD25 levels were significantly higher in patients with infection and sepsis. The ROC curve analysis revealed a similar diagnostic accuracy for infection (ROC area under the curve (AUC) PCT: 0·904; sCD25: 0·869 and PSP: 0·839) and for sepsis (ROC AUC: PCT: 0·820; sCD25: 0·835 and PSP: 0·872).


CONCLUSIONS
Pancreatic stone protein and sCD25 perform well as infection and sepsis biomarkers, with a similar performance than PCT, in ED patients with suspected infection. Further larger studies investigating use of PSP and sCD25 are needed.
Clinical Chemistry Laboratory, Santa Lucía Hospital, Cartagena, Spain.
Luis
L
García de Guadiana-Romualdo
Philips Handheld Diagnostics, Eindhoven, the Netherlands.
Mario
M
Berger
Clinical Chemistry Laboratory, Santa Lucía Hospital, Cartagena, Spain.
Enrique
E
Jiménez-Santos
Intensive Care Unit, Santa Lucía Hospital, Cartagena, Spain.
Sergio
S
Rebollo-Acebes
Intensive Care Unit, Santa Lucía Hospital, Cartagena, Spain.
Roberto
R
Jiménez-Sánchez
Clinical Chemistry Laboratory, Santa Lucía Hospital, Cartagena, Spain.
Patricia
P
Esteban-Torrella
Clinical Chemistry Laboratory, Santa Lucía Hospital, Cartagena, Spain.
Ana
A
Hernando-Holgado
Intensive Care Unit, Santa Lucía Hospital, Cartagena, Spain.
Alejandro
A
Ortín-Freire
Clinical Chemistry Laboratory, Santa Lucía Hospital, Cartagena, Spain.
María Dolores
MD
Albaladejo-Otón
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D002116:Calcitonin / Q000378:metabolism; D000066491:Clinical Decision-Making; D004636:Emergency Service, Hospital; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007239:Infections / Q000175:diagnosis*; D053645:Interleukin-2 Receptor alpha Subunit / Q000378:metabolism*; D051847:Lithostathine / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D018805:Sepsis / Q000175:diagnosis*; D055815:Young Adult
D015415:Biomarkers; C508017:IL2RA protein, human; D053645:Interleukin-2 Receptor alpha Subunit; D051847:Lithostathine; D002116:Calcitonin
Emergency department; infection; pancreatic stone protein; procalcitonin; sepsis; soluble CD25