Usefulness of presepsin in the diagnosis of sepsis in patients with or without acute kidney injury

BMC Anesthesiology

Yoshihiko Nakamura¹  Hiroyasu Ishikura¹  Takeshi Nishida¹  Yasumasa Kawano¹  Rie Yuge¹  Reiko Ichiki¹  Akira Murai¹ 

[1] Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan

关键词: Diagnosis;    Sepsis;    RIFLE criteria;    Acute kidney injury;    Presepsin;   

Others  :  1084361
DOI  :  10.1186/1471-2253-14-88

 received in 2014-02-21, accepted in 2014-09-24,  发布年份 2014

【 摘 要 】

Background

Presepsin is useful for differentiating sepsis from non-infection related systemic inflammatory response syndrome. However, there are no studies investigating the usefulness of presepsin in diagnosing sepsis involving patients with acute kidney injury (AKI). The purpose of this study is to determine levels of blood presepsin in patients with or without sepsis and among non-AKI patients or patients with different degrees of AKI severity.

Methods

This is a single center retrospective study. 247 patients admitted to the ICU between June 2010 and October 2012 were analyzed for their presepsin levels. We classified the patients into non-AKI and AKI according to the RIFLE (Risk, Injury, Failure, and Loss of kidney function and End-stage kidney disease or simply Loss and ESKD) criteria. We then sub-classified the patients in each group into either non-sepsis or sepsis sub-group and analyzed the accuracy of diagnosing sepsis based on their levels of presepsin.

Results

The number of patients for each group was: non-AKI, 112; under AKI: Risk, 50; Injury, 36; Failure, 42; Loss and ESKD, 7. The levels of presepsin in sepsis groups were significantly higher than that in the non-sepsis group among the non-AKI, Risk and Injury patients (p < 0.0001, p < 0.01, p < 0.01, respectively). However, no significant difference in the level of presepsin between non-sepsis and sepsis groups among patients with Failure. In the receiver operating characteristic (ROC) analysis, the area under the curve (AUC) was 0.784 in the non-AKI group and 0.698 in the AKI comprising Risk, Injury and Failure groups. AUC value for non-AKI was not significantly different from that of AKI (p = 0.200). When 670 pg/mL was used as the cutoff value for presepsin, sensitivity and specificity were 70.3% and 81.3%, respectively. When 864 pg/mL was used as the cutoff value for presepsin, sensitivity and specificity were 71.4% and 63.8%, respectively.

Conclusions

Presepsin level can be a reliable indicator of sepsis not only among non-AKI patients but also patients with less severe forms of AKI. However, it may not be a reliable indicator of sepsis in patients with a more advanced form of AKI.

【 授权许可】

   
2014 Nakamura et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM consensus conference committee. American college of chest physicians/society of critical care medicine. Chest 1992, 101:1644-1655.
• [2]Battleman DS, Callahan M, Thaler HT: Rapid antibiotic delivery and appropriate antibiotic selection reduce length of hospital stay of patients with community-acquired pneumonia: link between quality of care and resource utilization. Arch Intern Med 2002, 162:682-688.
• [3]Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, Suppes R, Feinstein D, Zanotti S, Taiberg L, Gurka D, Kumar A, Cheang M: Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006, 34:1589-1596.
• [4]Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M, Early Goal-Directed Therapy Collaborative G: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001, 345:1368-1377.
• [5]Bhatia BD, Basu S: Newer diagnostic tests for bacterial diseases. Indian J Pediatr 2007, 74:673-677.
• [6]Herzum I, Renz H: Inflammatory markers in SIRS, sepsis and septic shock. Curr Med Chem 2008, 15:581-587.
• [7]Christ-Crain M, Muller B: Procalcitonin in bacterial infections–hype, hope, more or less? Swiss Med Wkly 2005, 135:451-460.
• [8]Oda S, Hirasawa H, Shiga H, Nakanishi K, Matsuda K, Nakamua M: Sequential measurement of IL-6 blood levels in patients with systemic inflammatory response syndrome (SIRS)/sepsis. Cytokine 2005, 29:169-175.
• [9]Abe R, Oda S, Sadahiro T, Nakamura M, Hirayama Y, Tateishi Y, Shinozaki K, Hirasawa H: Gram-negative bacteremia induces greater magnitude of inflammatory response than gram-positive bacteremia. Critical care (London, England) 2010, 14:R27. BioMed Central Full Text
• [10]Endo S, Suzuki Y, Takahashi G, Shozushima T, Ishikura H, Murai A, Nishida T, Irie Y, Miura M, Iguchi H, Fukui Y, Tanaka K, Nojima T, Okamura Y: Usefulness of presepsin in the diagnosis of sepsis in a multicenter prospective study. J Infec Chemother Official J Japan Soc Chemotherap 2012, 18:891-897.
• [11]Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, Acute Dialysis Quality Initiative w: Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the second international consensus conference of the acute dialysis quality initiative (ADQI) group. Critical care (London, England) 2004, 8:R204-R212. BioMed Central Full Text
• [12]Kurihara T, Yanagida A, Yokoi H, Koyata A, Matsuya T, Ogawa J, Okamura Y, Miyamoto D: Evaluation of cardiac assays on a benchtop chemiluminescent enzyme immunoassay analyzer, PATHFAST. Anal Biochem 2008, 375:144-146.
• [13]Okamura Y, Yokoi H: Development of a point-of-care assay system for measurement of presepsin (sCD14-ST). Clinica Chim Acta Int J Clinical Chem 2011, 412:2157-2161.
• [14]Ricci Z, Ronco C, D’Amico G, De Felice R, Rossi S, Bolgan I, Bonello M, Zamperetti N, Petras D, Salvatori G, Dan M, Piccinni P: Practice patterns in the management of acute renal failure in the critically ill patient: an international survey. Nephrol dialysis Transplant Official Publ European Dialysis Transpl Assoc European Renal Assoc 2006, 21:690-696.
• [15]Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A, Collaborators developing the Japanese equation for estimated GFR: Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis Official J Nat Kidney Found 2009, 53:982-992.
• [16]Furusako SSK: Methods for detecting human low molecular weight CD14. United States Patent 2008, B2:US7465547.
• [17]Furusako SSK, Hirose J: Soluble CD14 antigen. United States Patent 2009, B2:US7608684.
• [18]Naito K: Method for evaluation of function of phagocyte. United States Patent 2011, A1:US0086381.
• [19]Shozushima T, Takahashi G, Matsumoto N, Kojika M, Okamura Y, Endo S: Usefulness of presepsin (sCD14-ST) measurements as a marker for the diagnosis and severity of sepsis that satisfied diagnostic criteria of systemic inflammatory response syndrome. J Infect Chemotherap Official J Japan Soc Chemotherap 2011, 17:764-769.
• [20]Murugan R, Kellum JA: Acute kidney injury: what’s the prognosis? Nat Rev Nephrol 2011, 7:209-217.
• [21]Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel RP: The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA J Am Med Assoc 1995, 273:117-123.
• [22]Yaegashi Y, Shirakawa K, Sato N, Suzuki Y, Kojika M, Imai S, Takahashi G, Miyata M, Furusako S, Endo S: Evaluation of a newly identified soluble CD14 subtype as a marker for sepsis. J Infect Chemotherap Official J Japan Soc Chemotherap 2005, 11:234-238.
• [23]Shirakawa K, Naitou K, Hirose J, Takahashi T, Furusako S: Presepsin (sCD14-ST): development and evaluation of one-step ELISA with a new standard that is similar to the form of presepsin in septic patients. Clinical Chem Lab Med CCLM / FESCC 2011, 49:937-939.