Measurement of a novel biomarker, secretory phospholipase A2 group IIA as a marker of sepsis: A pilot study

• Published in: Journal of emergencies, trauma and shock trauma and shock, 2018-04, Vol.11 (2), p.135-139
• Main Authors: Berg, Elena, Paukovits, Janel, Axelband, Jennifer, Trager, Jonathan, Ryan, Dina, Cichonski, Kathleen, Kopnitsky, Mark, Zweitzig, Daniel, Jeanmonod, Rebecca
• Format: Article
• Language: English
• Subjects: Bacterial infections; Biological markers; Biomarkers; Care and treatment; Diagnosis; Emergency medical care; Enzyme regulation; Genetic aspects; Health aspects; Identification and classification; Mortality; Original; Phospholipases; Sepsis; septic shock; Systematic review
• ISSN: 0974-2700; 0974-519X
• DOI: 10.4103/JETS.JETS_29_17

Introduction: Early identification of sepsis is critical as early treatment improves outcomes. We sought to identify threshold values of secretory phospholipase A2 (sPLA2)-IIA that predict sepsis and bacterial infection compared to nonseptic controls in an emergency department (ED) population. Materials and Methods: This is a prospective cohort of consenting adult patients who met two or more systemic inflammatory response syndrome (SIRS) criteria with clinical diagnosis of infectious source likely (septic patients). Controls were nonseptic consenting adults undergoing blood draw for other ED indications. Both groups had blood drawn, blind-coded, and sent to an outside laboratory for quantitative analysis of sPLA2-IIA levels. The study investigators reviewed patients' inpatient medical record for laboratory, imaging, and microbiology results, as well as clinical course. Results: sPLA2-IIA levels were significantly lower in control patients as compared to septic patients (median = 0 ng/ml [interquartile range (IQR): 0-6.5] versus median = 123 ng/ml [IQR 44-507.75]; P < 0.0001). SPLA2-IIA levels were higher in patients with confirmed source (n = 28 patients, median = 186 ng/ml, 95% confidence interval = 115.1-516.8) as compared to those with no source identified or a viral source (n = 17, median = 68 ng/ml, 95% confidence interval = 38.1-122.7; P = 0.04). Using a cutoff value of 25 ng/ml, sPLA2-IIA had a sensitivity of 86.7% (confidence interval 72.5-94.5) and a specificity of 91.1% (confidence interval 77.9-97.1) in detecting sepsis. Conclusions: sPLA2-IIA shows potential as a biomarker distinguishing sepsis from other disease entities. Further study is warranted to identify predictive value of trends in sPLA-IIA during disease course in septic patients.