| Objective:To monitor the levels of plasma presepsin of acute cholangitis(AC)patients admitted to hospital on the first day,explore the significance of presepsin in early diagnosis and severity judgement of AC,at the same time research the diagnostic value of presepsin on acute cholangitis combined by sepsis and the severity and prognosis of patients with sepsis associated with AC,to afford more sensitive biomarkers for the clinical diagnosis and treatment of AC and the related sepsis.Methods:119 patients with acute cholangitis were enrolled in the research.We divided them into different groups according to different analysis purposes:(1)In order to assess the diagnostic value of presepsin for the severity judgment of acute cholangitis patients,according to the Tokyo Guidelines 2013 for severity assessment of acute cholangitis,all the patients were divided into Gradel(mild infection),Grade?(moderate infection),and Grade?(severe infection)three groups.Meanwhile,we compared the presepsin levels before and after biliary drainage of severe infection patients.(2)In order to assess the sepsis early diagnostic value of presepsin for patients with acute cholangitis,all patients were divided into cholangitis group,sepsis group,and we set up healthy control group accordingly.In order to assess the diagnostic value of presepsin for the severity judgment of sepsis,according to systemic infection severity and whether associated with organ dysfunction,sepsis group can be divided into general sepsis,severe sepsis and septic shock three subgroups.(3)In order to assess the diagnostic value of presepsin in judging the prognosis of patients with sepsis,according to whether the sepsis patients survive 28 days,all the sepsis patients were divided into survival group and death group.Record the patients' personal basic clinical information,and the clinical data of 1 day of patients enrolled,Serum samples were obtained on admission for biomarkers detection through vain puncture phlebotomize,and operation patients were phlebotomized 12 hours and 24 hours after biliary drainage.All data were statistically analysized using SPSS 19.0 for Windows statistical software,Analysis of trend test was performed to assess the trend of mean stratified according to the Grade scale;the trend test was based on the Cochran-Armitage test.Receiver operating characteristic(ROC)curves were used to evaluate the diagnostic value of the markers,We tested the usefulness of biomarkers for clinical assessment of AC by calculating the area under the curve,at the same time,the optimal cut-off value of biomarkers were calculated by the Youden Index method,calculating their sensitivity and specificity of diagnosis accordingly.Analysis of risk factors for mortality in patients using univariate analysis to draw meaningful indicators,further multivariate Logistic regression analysis was used to analysis the risk factors affecting the prognosis of patients with sepsis.P-values of less than 0.05 were considered statistically significant.Results:1.According to trend testing between AC groups,a statistically significant increasing tendency was observed in CRP,PCT,presepsin,total bilirubin,BUN,Cr,PT-INR,APACHE-II score,SOFA score,discharge/death days and pulse along with the increase in AC groups.The difference between groups was statistically significant(P<0.05).A statistically significant declining tendency was observed in the average value of GGT,ALB,PLT and diastolic blood pressure(DBP)along with an increase in AC groups,the difference was statistically significant(P<0.05).At the same time,no difference was observed between Groups in age,sex,WBC,AST,ALT,ALP,systolic blood pressure,Sp02/Fi02 and disturbance of consciousness with an increase in subgroups of sepsis,the difference was statistically significant(P>0.05).Presepsin concentrations on admission were significantly higher in patients with severe AC than moderate AC(P<0.001)and higher than in patients with mild AC(P<0.001),at the same time,presepsin concentrations on admission were significantly higher in patients with moderate AC than mild AC(P<0.01).The difference was statistically significant,and presepsin levels were associated with AC severity.Using the Youden Index,the optimal cutoff for presepsin concentration for moderate AC was 493 pg/mL,the sensitivity and specificity were 87.2%and 88%,respectively.The optimal cutoff for presepsin concentration for severe AC was 637 pg/mL,the sensitivity and specificity were 89.3%and 90.1%;respectively.By calculating the AUC,analysis showed that the AUCs for presepsin,PCT,CRP,and WBC for discriminating patients with moderate AC to severe AC(versus mild AC)were 0.935(95%CI 0.877-0.993)?0.877(95%CI 0.810-0.943)?0.747(95%Cl 0.634-0.860)?0.578(95%Cl 0.474-0.682),respectively,the AUCs for presepsin,PCT,CRP,and WBC for discriminating patients with mild AC to moderate AC(versus severe AC)were 0.942(95%CI 0.885-0.998)?0.862(95%CI 0.788-0.935)?0.726(95%CI 0.610-0.842)?0.670(95%CI 0.537-0.804),and presepsin showed the highest value regarding the area under the curve,thus,presepsin was also a superior biomarker compared with the other markers.2.The median value of presepsin levels were 857(740-960)pg/mL?564.5(465-597)pg/mL and 262.5(230.25-291.75)pg/mL respectively for the severe infection cholangitis patients of before biliary drainage?12 hours after biliary drainage and 24 hours after biliary drainage.The difference between presepsin levels of before biliary drainage and 12 hours after biliary drainage was statistically significant(P<0.05).The difference between presepsin levels of 12 hours after biliary drainage and 24 hours after biliary drainage was also statistically significant(P<0.05).3.Compared with cholangitis group,clinical data that changes statistically significant in sepsis group was as follows:c-reactive protein(CRP),procalcitonin(PCT),Presepsin,gamma-Glutamyl transpeptidase(GGT),albumin(ALB),blood urea nitrogen(BUN),creatinine(Cr),diastolic blood pressure,and APACHE ? score,SOFA score and discharge/death days,the difference between the two groups of other clinical data was not statistically significant(P>0.05).Presepsin concentrations were significantly higher in patients with sepsis than healthy volunteers(P<0.001),and higher than in patients with AC(P<0.01),at the same time,presepsin concentrations were significantly higher in patients with AC than healthy volunteers(P<0.001).By calculating the area under receiver operating characteristic curves(AUC),analysis showed that the AUCs for presepsin,PCT,CRP and white blood cell(WBC)were 0.902(95%CI 95%CI,0.834-0.949,P<0.001),0.859(95%CI 0783-0.916,P<0.001),0.724(95%Cl 0.635-0.802,P=0.021)and 0.676(95%CI 0.585-0.759,P>0.05).From among WBC,CRP,PCT and presepsin,presepsin showed the highest value regarding the AUC.At this time,the optimal cut-off value of presepsin,PCT,and CRP calculated using the Youden Index method was 513 pg/mL,0.45 ng/mL and 1.25 mg/dL,respectively,and the sensitivity/specificity at this time was:presepsin:sensitivity=87.2%,specificity =88%;PCT:sensitivity=75.5%,specificity=84%;CRP:sensitivity=83%,specificity =60%.The sensitivity and specificity for WBC were low.4.According to Cochran-Armitage trend testing,a statistically significant increasing tendency was observed in CRP.PCT,presepsin,BUN,Cr,pulse frequency,APACHE-? score,SOFA score and discharge/death days along with the increase in subgroups of sepsis.The difference between groups was statistically significant(P<0.05).A statistically significant declining tendency was observed in the average value of ALB,PLT and diastolic blood pressure(DBP)along with an increase in subgroups of sepsis,the difference was statistically significant(P<0.05).At the same time,no difference was observed between Groups in age,sex,WBC,total bilirubin,aspertate aminotransferase(AST),Alanine aminotransferase(ALT),alkaline phosphatase(ALP),GGT,prothrombin time-the international standardization ratio(PT-INR),systolic blood pressure,Sp02/Fi02 and disturbance of consciousness with an increase in subgroups of sepsis,the difference was statistically significant(P>0.05).Presepsin concentrations on admission were significantly higher in patients with septic shock than severe sepsis(P<0.05),and higher than in patients with general sepsis(P<0.001),at the same time,presepsin concentrations on admission were significantly higher in patients with severe sepsis than general sepsis(P<0.01).The difference was statistically significant,and presepsin levels were associated with sepsis severity.By calculating the AUC,analysis showed that the AUCs for presepsin,PCT,CRP,and WBC for discriminating patients with severe sepsis to septic shock(versus general sepsis)were 0.825(95%CI 0.715-0.905)?0.732(95%CI 0.613-0.831)?0.646(95%CI 0.522-0.756)?0.536(95%CI 0.413-0.656),respectively,the AUCs for presepsin,PCT,CRP,and WBC for discriminating patients with general sepsis to severe sepsis(versus septic shock)were 0.873(95%CI 0.772-0.941)?0.792(95%CI 0.678-0.879)?0.672(95%CI 0.550-0.780)?0.634(95%CI 0.510-0.746),respectively.From among WBC,CRP,PCT,and presepsin,presepsin showed the highest value regarding the area under the curve;thus,presepsin was a superior biomarker compared with the other markers.Using the Youden Index,the optimal cutoff for presepsin concentration for severe sepsis was 587 pg/mL,the sensitivity and specificity were 86.7%and 87.5%,respectively.The optimal cutoff for presepsin concentration for septic shock was 725 pg/mL,the sensitivity and specificity were 88.5%and 87.3%,respectively.5.Univariate analysis showed that the difference of presepsin,PCT,CRP,ALB,BUN,Cr,APACHE-II score,SOFA score and hospitalization days between the survival group and death group was statistically significant in acute cholangitis patients with sepsis.Comparing the two groups,Presepsin,PCT,CRP,BUN,Cr,APACHEII scores,SOFA score,and hospitalization days were significantly higher in death group patients than survival group patients(P<0.05),at the same time,ALB concentrations were significantly lower in death group patients than survival group patients(P<0.05).Presepsin,PCT,CRP,ALB,BUN,Cr and APACHE-II score,SOFA score and hospitalization days were the independent risk factor of death for acute cholangitis patients with sepsis in Logistic binary regression analysis.The relative odds ratio(OR)value was 1.862,1.751,1.438,1.523,1.445,respectively(P<0.05).By calculating the AUC,analysis showed that the AUCs for presepsin,APACHE-? score,SOFA score were 0.876(95%CI 0.763-0.952)0.847(95%CI 0.573-0.850)and 0.807(95%CI 0.545-0.817),respectively,serum presepsin had a higher prognostic value than other biomarkers.Using the Youden Index,the optimal cutoff for presepsin concentration to predict sepsis mortality was 1016 pg/mL,the sensitivity and specificity were 87.3%?and 89.1%,respectively.Conclusions:Presepsin levels of biliary tract infection patients admitted to hospital on the first day increased obviously,and they were helpful to evaluate severity of biliary tract infection,the presepsin levels decreased evidently after biliary drainage for the severe cholangitis patients;the acute cholangitis patients with sepsis had higher presepsin levels,and with the increasing degree of the severity of sepsis,presepsin levels also increased accordingly,presepsin levels were also helpful to evaluate severity of sepsis.Presepsin levels on admission can be used as an independent risk factor for judging the prognosis of patients with sepsis.Compared with other traditional inflammatory biomarkers,Presepsin were more sensitive and specific in early diagnosis,severity and prognosis evaluation for patients of biliary tract infection and sepsis. |
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