Soluble CD14 Subtype—A New Biomarker in Predicting the Outcome of Critically Ill Septic Patients

• Published in: The American journal of the medical sciences 2017-06, Vol.353 (6), p.543-551
• Main Authors: Matera, Giovanni, Quirino, Angela, Peronace, Cinzia, Settembre, Pio, Marano, Vito, Loria, Maria T., Marascio, Nadia, Galati, Luisa, Barreca, Giorgio S., Giancotti, Aida, Amantea, Bruno, Liberto, Maria C., Focà, Alfredo
• Format: Article
• Language: English
• Subjects: Aged; Biomarkers - blood; C-Reactive Protein - metabolism; Calcitonin - blood; Critical Illness; CRP; Female; Humans; Lipopolysaccharide Receptors - blood; Male; Middle Aged; PCT; Peptide Fragments - blood; Presepsin; Prognosis; Prospective Studies; Sepsis - blood; Sepsis - diagnosis; Sepsis prognosis; SOFA score
• ISSN: 0002-9629; 1538-2990
• DOI: 10.1016/j.amjms.2017.03.036

We evaluated the role of presepsin (soluble CD14 subtype, sCD14-ST) in predicting the outcome of critically ill septic patients in parallel with procalcitonin and C-reactive protein. This study was an observational, prospective study that enrolled 58 surgical and medical intensive care unit patients with suspected sepsis. All studied subjects were retrospectively stratified into survivors and nonsurvivors based on 28 days survival and according to microbiological results in blood culture positive and negative groups. Plasma and serum samples from each patient were collected at admission (T-0), after 24-48 hours (T-1) and after 7 days (T-2). Statistics were obtained using Student׳s t test and ANOVA, as well as Bonferroni post hoc test. Receiver-operating characteristic (ROC) analysis was also performed. Presepsin levels were significantly higher at T-0 (P = 0.0007), at T-1 (P < 0.0001) and at T-2 (P < 0.0001) in nonsurvivors versus survivors at the same time point. Presepsin concentrations were significantly increased at T-0 (P = 0.0073), T1 (P = 0.0111) and T2 (P = 0.0167) in patients with positive blood cultures in comparison to patients with negative cultures at the same time. For all time periods evaluated, presepsin data from nonsurviving and surviving individuals were subjected to ROC analysis that demonstrated an excellent accuracy and significant area under the ROC curve (P < 0.0001). Results of multivariate analysis indicated presepsin as a predictive independent variable among prognosis markers at T-0 (P = 0.016). Presepsin revealed an optimal prognostic performance in patients with severe sepsis and provided interesting diagnostic value. Prediction of outcome in critically ill patients is crucial to optimize management decisions and level of treatment.