The Value Of Presepsin In The Diagnosis Of Sepsis And Evaluating Risk Stratification Of Sepsis

ObjectiveTo assess the diagnostic performance of soluble CD14subtype (sCD14-ST, presepsin)and investigate its influence on the risk stratification of sepsis.MethodsThis prospective study was conducted in72septic patients,23nonbacterial infectious SIRS parients, who were admitted to Department of Emergency Medicine, the General Hospital of Tianjin Medical University from December2012to August2013, and20aged-matched healthy control group. The blood presepsin PCT, Lactate and blood routine, et al. were measured, and APACHE II score were calculated at enrollment. The receiver-operating-characteristic curve (ROC) was drawn and the measure of area under the ROC curve was calculated to see its function in judging the value of diagnosing sepsis. Then the patients were grouped and compared according to the severity of sepsis, Spearman correlation analysis was applied to determine the correlation between presepsin, PCT, Lactate and APACHE Ⅱ score. The risk factors for influencing the prognosis of sepsis were analyzed by logistic regression analysis.The (ROC) was drawn and the measure of area below the ROC curve was calculated to see its function in judging the prognosis of sepsis. Then the patients were grouped and compared according to the severity of sepsis and the result of culture.For multi-group comparisons, Kruskal-Wallis one-way analysis of variance was applied, and two-groupcomparisons were performed nonparametrically using the Mann-Whitney U test.Results1、presepsin levels in patients with sepsis were significantly higher than in those with nonbacterial infectious SIRS and healthy control group (P<0.05, respectively).2、The area under the receiver operating characteristic curve was0.975for presepsin,0.881for PCT,0.875for CRP, and0.799for WBC. The cutoff value of presepsin for discrimination of sepsis and nonsepsis was determined to be407pg/ml, of which the clinical sensitivity and specificity were98.6%and90.7%, respectively.3、there were no significant differences in presepsin levels between the microbial culture-positive and culture-negative groups.(P>0.05)4、Presepsin levels did not differ significantly in patients with gram-positive, gram-negative bacterial infections, fungal infections and Mixed bacterial and fungal infections(P>0.05)5、The levels of presepsin and APACHE Ⅱ score incrcased with sepsis severity.6、In addition, a significant correlation was found between the APACHE II scores and the presepsin values(r=0.414,p=0.000<0.01).7、Logistic regression analysis indicated that the presepsin, lactate level, APACHE Ⅱscore were risk factors for prognosis of patients with sepsis.8、The measure of area below the ROC curve on presepsin was0.746, the sensitivity was75%and specificity was75%Conclusions1、Presepsin is a valuable biomarker for early diagnosis of sepsis.2、Presepsin is useful for evaluating the severity of sepsis.3、The presepsin level are the risk factor for prognosis of patients with sepsis.4、The presepsin levels in patients with sepsis are unrelated to pathogens.5、PCT is useful for early diagnosis of sepsis.