Clinical PotpourriUse of presepsin and procalcitonin for prediction of SeptiFast results in critically ill patients☆
Introduction
Sepsis mortality rates are high despite new antimicrobial and resuscitation agents [1], [2]. Early diagnose and suitable therapy are very important to a successful outcome of patients with sepsis [1], [2], [3], [4]. However occasionally it is very hard to distinguish between systemic inflammatory response syndrome (SIRS) and sepsis, and the treatment decisions often rely on clinicians' opinion and experience [1], [4].The decision regarding the administration of antimicrobial agents should be based on clinical and economic consequences, and probable development of antibiotic resistance should also been taken into account [5].
Many sepsis biomarkers have been studied in the last decade in order to distinguish sepsis from non-infectious SIRS and to guide antimicrobial therapy, evaluate the response to therapy and predict the course of sepsis [6].
Procalcitonin (PCT), a 116 amino acid peptide precursor of calcitonin, has been widely used and mostly recommended for identification and prognosis prediction of sepsis, but recent studies confirmed that this biomarker has limitations in differentiation of sepsis from other inflammatory conditions [6], [7].
Presepsin, a soluble fraction of CD 14, also known as sCD14-ST, is recently promoted as biomarker for identification of septic patients [8], [9], [10]. Data from literature bring evidence that phagocytosis in response to bacterial infection and probably lysosomal enzymes are involved in the mechanism of its production and that levels of this biomarker are significantly higher in patients with sepsis in comparison to patients with non-infectious SIRS and healthy people [10], [11].
Since early and optimized antimicrobial therapy is an imperative for successful treatment of patients with sepsis, early identification of microorganism that causes an infection is very important [3].
Blood cultures (BC) are the current gold standard for detecting blood stream infections and for providing susceptibility testing for appropriate treatment. However, they are associated with limitations such as delay in results and low sensitivity, especially after the initiation of antimicrobial treatment [12].
Necessity of improvement of current laboratory techniques for detection and identification of microorganisms responsible for bloodstream infections has led to development of new molecular techniques for identification of microorganisms present in the blood, such as PCR-based diagnostic tests [13].
Real-time PCR system that is targeting DNA sequences of microorganisms, such as SeptiFast (SF) has proven to be a good diagnostic test for detection of bloodstream infections [14]. This method has several advantages in comparison to BC and the most important one is the fast access to results which leads to early initiation of appropriate therapy. However, the economical aspect of this procedure, as well as the lack of guidelines about its laboratory performance with clinical diagnostic accuracy has limited its everyday use and narrowed the group of patients who could benefit from it [13], [14], [15].
Since identification of septic patients often can be difficult due to many non-specific signs of the disease, there is a need for identification of marker that could lead physicians to take the right step towards laboratory techniques for documentation of infection and timely administration of appropriate antimicrobial therapy.
The aim of this study was to investigate whether presepsin and PCT serum levels could predict BC and SF results, and help to select patients needing a SF or BC analysis to be performed.
The secondary aim of this study was to investigate the relationship of clinically widely accepted signs of possible sepsis (fever, leukocytosis, high CRP concentration, SOFA (Sequential Organ Failure Assessment) and APACHE (Acute Physiology and Chronic Health Evaluation) II score) with the presence of microorganism in the blood.
Section snippets
Material and methods
This is a retrospective study for two years study period of medical records of patients treated at The Department of Anesthesia and Reanimation of Emergency center - Clinical center of Vojvodina, who were suspected to have sepsis according to criteria defined at The ACCP/SCCM Consensus Conference Committee American College of Chest Physicians/Society of Critical Care Medicine 1992, revised on SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference 2001 and by the Surviving Sepsis
Results
Among 100 patients with suspected sepsis according to defined criteria [3], [16], [17] treated in the Department of anaesthesia and reanimation of Emergency centre of Clinical centre of Vojvodina, 71% were males and 29%were females, 19 to 80 years old.
Clinical characteristics of patients with sepsis are shown in Table 1.
Respiratory tract was the most common site of infection (42%), followed by abdominal infections, (31%), urinary tract infections (13%), soft tissue infections (10%), infections
Discussion
Identification of septic patients in critical care population represents a great challenge to clinicians, because most of the patients that are treated in ICU-s for some time often have signs of SIRS and are susceptible to infections since they are immunocompromised [20], [21].
There is ongoing search for the optimal biomarker that could differentiate non-infectious SIRS from sepsis, and the identification of the microorganism responsible for infection is considered the “holy grail” and the
Conclusion
Based on our research presepsin can serve as good predictor of bacteremia detected by SF (AUC 0.73), and in our opinion it should be included as “significant other” with PCT in protocols for sepsis diagnosing, since it is better marker of infection than CRP and other clinical parameters that are used for identification of septic patients.
Acknowledgements (Authors' contributions)
D. Mihajlovic: designed research, performed research/study, collected data, analyzed data, wrote paper.
S. Brkic: designed research, performed research/study, collected data, wrote paper.
A. Uvelin: performed research/study, collected data.
B. Draskovic: designed research, performed research/study, collected data.
V. Vrsajkov: performed research/study, collected data.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Cited by (20)
Clinical importance and characteristics of secondary culture-negative sepsis after surgery for abdominal infection: A retrospective study
2023, Asian Journal of SurgeryCitation Excerpt :Zhongjun Zheng et al showed presepsin has moderate diagnostic capacity for the detection of sepsis.22 And, Dunja Mihajlovic et al reported presepsin can serve as good predictor of bacteremia.23 Also, Yoshihiko Nakamura et al showed presepsin level can be a reliable indicator of sepsis not only among non-AKI patients but also patients with less severe forms of AKI.24
Role of procalcitonin in predicting etiology in bacteremic patients: Report from a large single-center experience
2020, Journal of Infection and Public HealthCitation Excerpt :The early identification of etiologies is crucial to overcome treatment delays and inappropriate therapies [6]. Procalcitonin (PCT) is a biomarker with a potential role in diagnosis and prognosis of bacterial infections, since its values appeared strictly correlated with the development of severe bacterial infections [7–9]. Systematic use of PCT has been proposed as part of the initial diagnostic pathway and for monitoring antibiotic treatment response and duration, especially in critically ill patients [10,11].
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On behalf of all authors, the corresponding author states that there is no conflict of interest.