Prognostic importance of serum presepsin level in pneumonia focal sepsis and its relationship with other biomarkers and clinical severity scores

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Figure 1
- Comparison of inflammatory biomarker levels between 3 groups. The figure shows that all biomarker levels were found to be significantly higher in the sepsis group than in the pneumonia group. However, there was no statistically significant difference between sepsis and septic shock in all biomarkers.
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Figure 2
- Correlation of presepsin levels with other biomarkers and severity scores. The figure shows the significant correlation of plasma presepsin levels with procalcitonin, c-reactive protein, lactate, pneumonia severity index (PSI) and quick sequential organ failure assessment (qSOFA).

Table 1

- Comparison of vital and laboratory values of 3 groups.

Variables	Pneumonia (n=80)	Sepsis (n=51)	Septic shock (n=45)	P-value
Variables	Mean±SD
Age, year	69.29±14.30^b,c	75.47±10.85^a	76.20±8.76^a	0.001
Systolic blood pressure, mm Hg	124.64±20.93^b,c	102.37±21.04^a,c	96±13.42^a,b	0.000
Diastolic blood pressure, mm Hg	71.05±12.50^b,c	62.15±12.36^a	58±8.37^a	0.000
Pulse/min	99.25±19.60^b,c	106.21±26.00^a	91.80±23.89^a	0.014
Relative risk/min	21.19±3.92^b,c	23.95±2.70^a	25.60±3.65^a	0.000
Temperature °C	37.05±0.79^b,c	37.51±1.07^a	37.98±1.73^a	0.000
White blood cells, 10³/µL	13.5±5.9	15.3±8.5	15.6±11.6	0.58
Hemoglobin, g/dL	12.65±2.47	12.68±1.88	11.64±2.60	0.12
Platelet, 10³/µL	276000±139339^c	225178±123663	213955±132081^a	0.014
Glucose, mg/dL	164.25±87.44	186.56±87.17	159.31±56.99	0.13
Urea, mg/dL	62.89±35.94^b,c	108.74±67.75^a	134.98±83.05^a	0.000
Creatinine, mg/dL	1.24±0.52^b,c	1.87±1.07^a	2.24±1.25^a	0.000
Sodium, mmol/L	135.76±4.61^b,c	141.39±11.04^a	139.56±8.58^a	0.004
Lactate, mmol/L	2.45±1.62^b,c	4.40±3.23^a	4.03±2.56^a	0.000
Erythrocyte sedimentation rate, mm/h	46.05±28.86^b,c	35.74±25.16^a	36.25±31.58^a	0.04
C-reactive protein, mg/dL	156.54±168.73^b,c	207.78±127.48^a	231.85±131.81 ^a	0.001
Procalcitonin, ng/mL	5.87±13.72^b,c	20.80±28.91^a	26.97±34.69^a	0.000
Presepsin, ng/mL	5.44±5.34^b,c	7.37±4.74^a	12.00±23.70^a	0.000
qSOFA	1;1^b,c	2;1^a,c	3;1^a,b	0.000
Pneumonia severity index	134.02±32.38^b,c	149.45±26.47^a,c	162.36±32.59^a,b	0.000

Table 2

- Comparison of vital and laboratory values of the 3 groups for 30-day mortality.

Variables	Survivors (n=96)	Non-survivors (n=80)	P-value
Variables	Mean±SD (min-max)
Age, year	69.5±15.04 (24-91)	78.67±10.65 (49-103)	0.000
Systolic blood pressure, mm Hg	115.20±26.68 (60-184)	99.67±19.73 (60-170)	0.000
Diastolic blood pressure, mm Hg	67.71±14.07 (40-130)	58.71±10.49 (37-90)	0.000
Pulse/min	103.85±23.19 (70-190)	107.66±23.90 (60-161)	0.18
Relative risk/min	22; 4 (12-40)	25; 5 (15-34)	0.001
Temperature °C	37.26±0.90 (35.6-41)	37.57±1.01 (35.8-40)	0.03
White blood cells, 10³/µL	14.0±7.2 (2.5-41.2)	15.3±9.8 (2.6-70.3)	0.42
Hemoglobin, g/dL	12.76±2.33 (6.20-17.90)	11.98±2.39 (4-18.20)	0.05
Platelet, 10³/µL	275.3±137.8 (73.0-676.0)	209.5±123.8 (26.0-628.0)	0.001
Glucose, mg/dL	169.26±94.06 (74-495)	169.69±62.46 (71-320)	0.09
Urea, mg/dL	70.96±50.25 (19-340)	122.99±74.72 (34-461)	0.000
Creatinine, mg/dL	1.42±0.75 (0.41-4.02)	1.99±1.18 (0.66-5.62)	0.000
Sodium, mmol/L	136.07±6.62 (108-160)	141.11±9.29 (123-172)	0.000
Lactate (mmol/L)	2.80±2.03 (0.8-13.8)	4.17±2.96 (0.9-2.80)	0.000
Erythrocyte sedimentation rate, mm/h	43.33±28.80 (2-120)	37.24±28.72 (2-111)	0.12
C-reactive protein, mg/dL	155.64±113.96 (6.99-449)	218.81±133.23 (9.12-483)	0.002
Procalcitonin, ng/mL	11.42±22.37 (0.00-100)	20.52±30.37 (0.10-100)	0.000
Presepsin, ng/mL	6.07±5.87 (0.00-27.8)	7.87±4.93 (0.50-24.4)	0.001
Pneumonia severity index	136.16±33.75 (61-230)	157.24±27.80 (99-223)	0.000
qSOFA (median; IQR)	1;2 (0-3)	2;1 (0-3)	0.000

Table 3

- Receiver operator characteristic (ROC) analysis results for 30-day mortality determination and septic shock.

Variables	AUC	SE	95% CI	Cut-off	Sensitivity	Specificity
For mortality
Presepsin	0.644	0.0415	0.568-0.714	>4.57	73.7	55.2
Procalcitonin	0.666	0.0409	0.591-0.735	>0.9	83.7	49.0
C-reactive protein	0.634	0.0422	0.558-0.705	>257	38.7	84.4
Lactate	0.655	0.0414	0.579-0.724	>2.3	70.0	56.2
Pneumonia severity index	0.690	0.0397	0.616-0.757	>131	83.7	50.0
qSOFA	0.748	0.0355	0.677-0.810	>1	77.5	65.6
For septic shock
Presepsin	0.650	0.0445	0.574-0.721	>3.9	84.4	44.3
Procalcitonin	0.678	0.0457	0.604-0.747	>2.4	80.0	48.0
C-reactive protein	0.636	0.0481	0.560-0.707	>232	48.9	75.6
Lactate	0.618	0.0475	0.542-0.690	>1.9	82.2	40.5
Pneumonia severity index	0.688	0.0476	0.614-0.755	>163	53.3	80.1
qSOFA	0.855	0.0251	0.794-0.903	>1	100.0	61.3

AUC: area under curve, qSOFA: quick sequential organ failure assessment, CI: confidence interval

Table 4

- Univariate and multivariate logistic regression analysis for 30-day mortality.