The Clinical Value Of Presepsin In The Early Diagnosis And Prognosis Of Sepsis

Objective In this experiment,the determination of soluble CD14 subtype(sCD14-ST,Presepsin)and procalcitonin(PCT)and other commonly used biomarkers,APACHE score and SOFA score were determined to explore their early diagnosis and prognostic value in sepsis in patients with systemic inflammatory response syndrome(SIRS).Methods Using prospective research methods.From September 2017 to February 2018,patients admitted to the ICU of the Second Hospital of Lanzhou University who meet the diagnostic criteria of SIRS were selected as the study subjects.According to the definition of sepsis 3.0,the subjects were divided into sepsis group,normal SIRS group and normal healthy subjects in Lanzhou University Second Hospital.Plasma samples were collected immediately after the subject was hospitalized.Pre-clinical markers such as Presepsin and PCT were detected and APACHE II scores and SOFA scores were recorded.Their levels in the three groups were compared and ROC curves were plotted to assess their diagnostic value for sepsis.According to the 28-day prognosis,sepsis patients were divided into death group and survival group.The levels of Presepsin,commonly used markers and score in the 2 groups were compared.The ROC curve was drawn to evaluate the predictive value of Presepsin for the prognosis of sepsis patients.Results1.The level of Presepsin in sepsis group was higher than that in SIRS group and control group[ 957.0(536.7,1413.5)pg/mL vs.506.4(356.8,576.1)pg/mL vs.136.0(81.2,354.1)pg/mL,P<0.05].The difference was statistically significant compared with the PCT,Lac,APACHE II scores and SOFA scores in the sepsis group and the SIRS group(P <0.05).2.Analyze and draw scatter charts on inclusion criteria.Presepsin levels in patients with sepsis were positively correlated with PCT,Lac,APACHEⅡscore and SOFA scores(P <0.05).3.The area under the ROC curve of Presepsin in diagnosing sepsis was 0.889,and the specificity was 92.5% and the sensitivity was 80% at the cutoff point of 796.4 pg/mL.Presepsin,PCT,and SOFA scores were superior to other indicators in predicting sepsis.Logistic regression was used to predict the sepsis by combining Presepsin,PCT,and SOFA scores.The AUC was0.924,and the diagnostic efficacy of the three combined tests was improved.4.The Presepsin level in death group was significantly higher than that in survival group,the difference was statistically significant[1372.0(964.7,2454.0)pg/mL vs.555.0(278.2,915.0)pg/mL,P<0.05 ].PCT,Lac,CRP,APACHE Ⅱ score,SOFA score between the two groups were statistically significant.The PLT,WBC no difference between the two groups.5.The prognosis of sepsis was evaluated with Presepsin,PCT,Lac,CRP,APACHE II,and SOFA scores,and the ROC curve was plotted to calculate the area under the curve.The AUC of Presepsin was 0.827(second only to Lac),with a specificity of 77.4% and a sensitivity of 82.8% at a cutoff point of 935.80 pg/mL.Logistic regression method was used to combine Presepsin,Lac and SOFA scores.The area under the ROC curve was used to evaluate the 28-day mortality of sepsis patients.The AUC of the combination test was 0.876,which was significantly higher than other indexes.Conclusion Presepsin is a good biomarker for early diagnosis of sepsis and has better predictive ability than the commonly used clinical markers and scoring.Presepsin has the ability to early identify patients with sepsis from patients with SIRS characteristics and has a significant positive correlation with PCT,Lac,APACHE II score and SOFA score in sepsis diagnosis.Presepsin combined with PCT,SOFA score can significantly improve the early diagnosis of sepsis.Lac,Presepsin,and SOFA scores showed good predictive power in predicting the prognosis of sepsis.Presepsin predictive power was not as good as Lac and superior to SOFA.Presepsin combined with Lac,SOFA score can significantly improve the prognosis of sepsis ability to predict.