Diagnostic accuracy of presepsin compared with several biomarkers to 6 predict sepsis and septic shock in infected patients, according to Sepsis-3 7 definition. (PREDI study)
Resumen
Objectives: Accurate diagnosis of sepsis in the setting of emergency department is key toinitiate the right treatment. Several biomarkers could help physician in this step. The aim of thisstudy was to assess the diagnostic accuracy of blood presepsin, compared to lactate, C-reactiveprotein (CRP) and procalcitonin (PCT), in the presence of sepsis according to the Sepsis-3definition.
Methods: Single-center, prospective, observational cohort study, conduct in an emergency department (ED) of a university hospital. Three hundred and fifty-nine patients with a clinical presumption of infection and at least two or more S.I.R.S criteria were included. Among them,63.5% were in sepsis and 5.6% in septic shock. At admission, Presepsin, PCT, CRP and lactate were measured at bedside in blood sample.
Results: In our cohort, PCT and presepsin were the best biomarkers to predict sepsis with an area under the ROC curve (AUC) of 0.711 (95%-IC: 0.660-0.758) and 0.709 (0.658-0.756), respectively, compared to lactate or CRP (p<0.05). Using a positive threshold of 0.25ng/ml for PCT and 500pg/ml for presepsin, the Odds Ratios to predict sepsis were 2.51 for PCT and 3.19 for presepsin. However, the diagnosis of sepsis was not improved by the combination of presepsin and PCT (AUC:0.71, 95%-CI 0.66-0.76) compared to PCT alone. PCT was the more accurate predictor of bacteremia in infected patients (AUC 0.835; 95%-CI 0.79-0.87, p<0.001).
Conclusion: Our results support that presepsin and PCT seem to be the most effective biomarkers to improve bedside diagnosis of sepsis and septic shock in the ED.
Palabras Clave
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