1
|
Gatto A, Mantani L, Gola C, Pansini V, Di Sarno L, Capossela L, Ferretti S, Graglia B, Chiaretti A. Presepsin Levels in Pediatric Patients with Fever and Suspected Sepsis: A Pilot Study in an Emergency Department. CHILDREN (BASEL, SWITZERLAND) 2024; 11:594. [PMID: 38790589 PMCID: PMC11119862 DOI: 10.3390/children11050594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024]
Abstract
Sepsis is a life-threatening condition that affects 1.2 million children annually. Although there are several criteria for diagnosing this condition, signs are often nonspecific, and identifying sepsis is challenging. In this context, presepsin (P-SEP) seems to be a promising new biomarker since its plasma levels increase earlier than other sepsis-related proteins and its measurement is faster. We enrolled 157 minors who presented to the Pediatric Emergency Department of Agostino Gemelli Hospital with fever and suspected sepsis. Biochemical, anamnestic, and clinical data were collected. Viral agents were identified as the causative factor in 64 patients, who had an average P-SEP value of 309.04 pg/mL (SD ± 273.2), versus an average P-SEP value of 526.09 pg/mL (SD ± 657) found in 27 bacterial cases (p value: 0.0398). Four cases of overt sepsis had an average P-SEP value of 3328.5 pg/mL (SD ± 1586.6). The difference in P-SEP levels in viral versus bacterial infections was found to be statistically significant; therefore, P-SEP may have a central role in the evaluation of febrile children, helping clinicians distinguish between these two etiologies. Furthermore, amongst the cases of confirmed sepsis, P-SEP was always greater than 2000 pg/mL, while C-reactive protein and procalcitonin values appeared lower than what was considered significant.
Collapse
Affiliation(s)
- Antonio Gatto
- Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli—IRCCS, 00168 Rome, Italy;
| | - Lucia Mantani
- Department of Pediatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.M.); (C.G.); (L.D.S.); (L.C.); (S.F.); (B.G.)
| | - Caterina Gola
- Department of Pediatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.M.); (C.G.); (L.D.S.); (L.C.); (S.F.); (B.G.)
| | - Valeria Pansini
- Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli—IRCCS, 00168 Rome, Italy;
| | - Lorenzo Di Sarno
- Department of Pediatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.M.); (C.G.); (L.D.S.); (L.C.); (S.F.); (B.G.)
| | - Lavinia Capossela
- Department of Pediatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.M.); (C.G.); (L.D.S.); (L.C.); (S.F.); (B.G.)
| | - Serena Ferretti
- Department of Pediatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.M.); (C.G.); (L.D.S.); (L.C.); (S.F.); (B.G.)
| | - Benedetta Graglia
- Department of Pediatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.M.); (C.G.); (L.D.S.); (L.C.); (S.F.); (B.G.)
| | - Antonio Chiaretti
- Department of Women’s Health Sciences, Fondazione Policlinico Universitario A. Gemelli—IRCCS, 00168 Rome, Italy;
| |
Collapse
|
2
|
Feng A, Pokharel MD, Liang Y, Ma W, Aggarwal S, Black SM, Wang T. Free Radical-Associated Gene Signature Predicts Survival in Sepsis Patients. Int J Mol Sci 2024; 25:4574. [PMID: 38674159 PMCID: PMC11049877 DOI: 10.3390/ijms25084574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Sepsis continues to overwhelm hospital systems with its high mortality rate and prevalence. A strategy to reduce the strain of sepsis on hospital systems is to develop a diagnostic/prognostic measure that identifies patients who are more susceptible to septic death. Current biomarkers fail to achieve this outcome, as they only have moderate diagnostic power and limited prognostic capabilities. Sepsis disrupts a multitude of pathways in many different organ systems, making the identification of a single powerful biomarker difficult to achieve. However, a common feature of many of these perturbed pathways is the increased generation of reactive oxygen species (ROS), which can alter gene expression, changes in which may precede the clinical manifestation of severe sepsis. Therefore, the aim of this study was to evaluate whether ROS-related circulating molecular signature can be used as a tool to predict sepsis survival. Here we created a ROS-related gene signature and used two Gene Expression Omnibus datasets from whole blood samples of septic patients to generate a 37-gene molecular signature that can predict survival of sepsis patients. Our results indicate that peripheral blood gene expression data can be used to predict the survival of sepsis patients by assessing the gene expression pattern of free radical-associated -related genes in patients, warranting further exploration.
Collapse
Affiliation(s)
- Anlin Feng
- Center for Translational Science, Florida International University, Port Saint Lucie, FL 34987, USA
- Department of Environmental Health Sciences, Florida International University, Miami, FL 33199, USA
| | - Marissa D. Pokharel
- Center for Translational Science, Florida International University, Port Saint Lucie, FL 34987, USA
- Department of Cellular and Molecular Medicine, Florida International University, Miami, FL 33199, USA
| | - Ying Liang
- Center for Translational Science, Florida International University, Port Saint Lucie, FL 34987, USA
- Department of Environmental Health Sciences, Florida International University, Miami, FL 33199, USA
| | - Wenli Ma
- Center for Translational Science, Florida International University, Port Saint Lucie, FL 34987, USA
- Department of Environmental Health Sciences, Florida International University, Miami, FL 33199, USA
| | - Saurabh Aggarwal
- Center for Translational Science, Florida International University, Port Saint Lucie, FL 34987, USA
- Department of Cellular and Molecular Medicine, Florida International University, Miami, FL 33199, USA
| | - Stephen M. Black
- Center for Translational Science, Florida International University, Port Saint Lucie, FL 34987, USA
- Department of Environmental Health Sciences, Florida International University, Miami, FL 33199, USA
- Department of Cellular and Molecular Medicine, Florida International University, Miami, FL 33199, USA
| | - Ting Wang
- Center for Translational Science, Florida International University, Port Saint Lucie, FL 34987, USA
- Department of Environmental Health Sciences, Florida International University, Miami, FL 33199, USA
- Department of Cellular and Molecular Medicine, Florida International University, Miami, FL 33199, USA
| |
Collapse
|
3
|
Long J, Zhang J, Chen G, Su X, Qiu B, Dong Q. Pediatric perforated appendicitis diagnosis based on the C-reactive protein/prealbumin ratio. Sci Rep 2024; 14:6729. [PMID: 38509094 PMCID: PMC10954718 DOI: 10.1038/s41598-024-55108-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/20/2024] [Indexed: 03/22/2024] Open
Abstract
Pediatric perforated appendicitis, prone to multiple complications, necessitates identifying potential serum biomarkers for early diagnosis and intervention. A cross-sectional study was conducted on patients under 16 with acute appendicitis, admitted to Hainan Women and Children's Medical Center from January 2019 to July 2023. The patients were categorized into perforated and non-perforated groups. Among the 313 included patients, 106 (33.87%, 95% CI 28.59-39.14%) developed perforation. The C-reactive protein to prealbumin ratio (CPA) showed a significant difference between the perforated and non-perforated groups [6.63 (2.9-13.02) vs. 0.7 (0.11-2.18), p < 0.001]. The AUC of CPA on the ROC curve was 0.691 (95% CI 0.513-0.869, p = 0.084) in patients under 4. In patients aged 4-9, the sensitivity of CPA > 3 predicting perforation was 76.2%, with a specificity of 81.6%, and an AUC of 0.816 (95% CI 0.747-0.886, p < 0.001). For patients aged 9-16, the sensitivity of CPA > 2.2 predicting perforation was 85%, with a specificity of 85.7%, and an AUC of 0.919 (95% CI 0.859-0.979, p < 0.001). CPA > 3 and CPA > 2.2 can predict perforated appendicitis in patients aged 4-9 and 9-16, respectively.
Collapse
Affiliation(s)
- Junshan Long
- Department of General Surgery, Hainan Women and Children's Medical Center, Changbin Road, Haikou, Hainan, China
| | - Jing Zhang
- Department of General Surgery, Hainan Women and Children's Medical Center, Changbin Road, Haikou, Hainan, China
| | - Gong Chen
- Department of General Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaoxia Su
- Department of General Surgery, Hainan Women and Children's Medical Center, Changbin Road, Haikou, Hainan, China
| | - Baowei Qiu
- Department of General Surgery, Hainan Women and Children's Medical Center, Changbin Road, Haikou, Hainan, China
| | - Qi Dong
- Department of General Surgery, Hainan Women and Children's Medical Center, Changbin Road, Haikou, Hainan, China.
| |
Collapse
|
4
|
Marin MJ, van Wijk XMR, Chambliss AB. Advances in sepsis biomarkers. Adv Clin Chem 2024; 119:117-166. [PMID: 38514209 DOI: 10.1016/bs.acc.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Sepsis, a dysregulated host immune response to an infectious agent, significantly increases morbidity and mortality for hospitalized patients worldwide. This chapter reviews (1) the basic principles of infectious diseases, pathophysiology and current definition of sepsis, (2) established sepsis biomarkers such lactate, procalcitonin and C-reactive protein, (3) novel, newly regulatory-cleared/approved biomarkers, such as assays that evaluate white blood cell properties and immune response molecules, and (4) emerging biomarkers and biomarker panels to highlight future directions and opportunities in the diagnosis and management of sepsis.
Collapse
Affiliation(s)
- Maximo J Marin
- Department of Pathology, Immunology & Laboratory Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Allison B Chambliss
- Department of Pathology & Laboratory Medicine, University of California Los Angeles, Los Angeles, California, USA
| |
Collapse
|
5
|
Rodgers O, Mills C, Watson C, Waterfield T. Role of diagnostic tests for sepsis in children: a review. Arch Dis Child 2024:archdischild-2023-325984. [PMID: 38262696 DOI: 10.1136/archdischild-2023-325984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Abstract
Paediatric sepsis has a significant global impact and highly heterogeneous clinical presentation. The clinical pathway encompasses recognition, escalation and de-escalation. In each aspect, diagnostics have a fundamental influence over outcomes in children. Biomarkers can aid in creating a larger low-risk group of children from those in the clinical grey area who would otherwise receive antibiotics 'just in case'. Current biomarkers include C reactive protein and procalcitonin, which are limited in their clinical use to guide appropriate and rapid treatment. Biomarker discovery has focused on single biomarkers, which, so far, have not outperformed current biomarkers, as they fail to recognise the complexity of sepsis. The identification of multiple host biomarkers that may form a panel in a clinical test has the potential to recognise the complexity of sepsis and provide improved diagnostic performance. In this review, we discuss novel biomarkers and novel ways of using existing biomarkers in the assessment and management of sepsis along with the significant challenges in biomarker discovery at present. Validation of biomarkers is made less meaningful due to methodological heterogeneity, including variations in sepsis diagnosis, biomarker cut-off values and patient populations. Therefore, the utilisation of platform studies is necessary to improve the efficiency of biomarkers in clinical practice.
Collapse
Affiliation(s)
- Oenone Rodgers
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Clare Mills
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Chris Watson
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Thomas Waterfield
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| |
Collapse
|
6
|
Yoshinari H, Kawahara Y, Niijima H, Oh Y, Morimoto A. High Plasma Presepsin Levels in Children With Hemophagocytic Lymphohistiocytosis. J Pediatr Hematol Oncol 2024; 46:e103-e106. [PMID: 37910819 DOI: 10.1097/mph.0000000000002779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/06/2023] [Indexed: 11/03/2023]
Abstract
Presepsin is reported as a novel diagnostic and prognostic biomarker for sepsis, and its optimal cutoff value is reported to be 600 to 650 pg/mL. Three children were diagnosed with hemophagocytic lymphohistiocytosis (HLH). The cause of HLH was unknown in cases 1 and 2, while Epstein-Barr virus infection was the cause in case 3. The plasma presepsin levels at the diagnosis were 1020, 1080, and 3160 pg/mL in cases 1, 2, and 3, respectively. In case 1, the plasma level of presepsin decreased to 164 pg/mL on day 19 of her sickness, when symptoms improved. Follow-up plasma presepsin levels were missing for cases 2 and 3. No microbiological pathogens were detected in the blood cultures of any of the patients. Our cases suggest that plasma presepsin levels can be elevated in childhood HLH.
Collapse
Affiliation(s)
- Hiroki Yoshinari
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | | | | | | | | |
Collapse
|
7
|
Mao S, Wu L, Shi W. Changing trend of neonatal Ca/P/Mg status in a Chinese population. Transl Pediatr 2023; 12:1659-1667. [PMID: 37814713 PMCID: PMC10560350 DOI: 10.21037/tp-23-129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/02/2023] [Indexed: 10/11/2023] Open
Abstract
Background Calcium (Ca), phosphorus (P), and magnesium (Mg) are essential elements for keeping the body homeostasis. We aimed to investigate the changing trend of serum levels of Ca/P/Mg in neonates. Methods We enrolled 82 premature newborns, 173 neonatal sepsis, 50 neonatal hypoglycemia, 254 neonatal jaundice, 43 neonatal haemolytic disease, and 59 healthy controls in our retrospective study. Serum levels of Ca/P/Mg were collected and expressed in quarters. We analysed the association between neonatal disorders and Ca/P/Mg levels (fourth quarter vs. first quarter) using binary logistic regression analysis. Smooth curve analysis was performed to analyze the non-linear association between birthweight/procalcitonin (PCT) and Ca/P levels. Threshold effect analysis was also performed to yield the turning point of birthweight/PCT in their associations with Ca/P levels. Results Binary logistic regression analyses showed that neonatal haemolytic disease, hypoglycemia, sepsis, jaundice, and prematurity were all significantly associated with the fourth quarter of Ca level (P<10-4; P<10-4; P<10-4; P=0.001; and P<10-4, respectively). Neonatal hypoglycemia and prematurity were significantly associated with the fourth quarter of P level (P=0.004; and P=0.003, respectively). Neonatal haemolytic disease, hypoglycemia, sepsis, jaundice and prematurity were not associated with Mg level. Birthweight was significantly associated with Ca level before and after the turning point of 3,220 grams. PCT was significantly associated with Ca level before and after the turning point of 16.8 µg/L. Birthweight was significantly associated with P level before the turning point of 2,990 gram. PCT was significantly associated with P level before the turning points of 3.5 and 34.21 µg/L. Conclusions Neonatal disorders demonstrated a decreasing trend of serum Ca/P level. A significantly non-linear association was observed between birthweight/PCT and serum Ca/P levels.
Collapse
Affiliation(s)
- Song Mao
- Department of Pediatrics, Shanghai Sixth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liangxia Wu
- Department of Pediatrics, Shanghai Sixth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjing Shi
- Department of Pediatrics, Shanghai Sixth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
8
|
Guo BC, Chen YT, Chang YJ, Chen CY, Lin WY, Wu HP. Predictors of bacteremia in febrile infants under 3 months old in the pediatric emergency department. BMC Pediatr 2023; 23:444. [PMID: 37679686 PMCID: PMC10483716 DOI: 10.1186/s12887-023-04271-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023] Open
Abstract
INTRODUCTION Fever may serve as the primary indicator of underlying infection in children admitted to the pediatric emergency department (PED), especially in high-risk young infants. This study aimed to identify early clinical factors that could help predict bacteremia in young febrile infants. METHODS The study included infants under 90 days of age who were admitted to the PED due to fever. Patients were divided into two groups based on the presence or absence of bacteremia and further divided into three age groups: (1) less than 30 days, (2) 30 to 59 days, and (3) 60 to 90 days. Several clinical and laboratory variables were analyzed, and logistic regression and receiver operating characteristic (ROC) analyses were used to identify potential risk factors associated with bacteremia in young febrile infants. RESULTS A total of 498 febrile infants were included, of whom 6.4% were diagnosed with bacteremia. The bacteremia group had a higher body temperature (BT) at triage, especially in neonates, higher pulse rates at triage, longer fever subsidence time, longer hospital stays, higher neutrophil counts, and higher C-reactive protein (CRP) levels than those of the non-bacteremia group. ROC analysis showed that the best cut-off values for predicting bacteremia in infants with pyrexia were a BT of 38.7 °C, neutrophil count of 57.9%, and CRP concentration of 53.8 mg/L. CONCLUSIONS A higher BT at triage, increased total neutrophil count, and elevated CRP levels may be useful for identifying bacteremia in young febrile infants admitted to the PED.
Collapse
Affiliation(s)
- Bei-Cyuan Guo
- Department of Pediatrics, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Yin-Ting Chen
- Division of Neonatology, Department of Pediatrics, Children Hospital, China Medical University, Taichung, Taiwan
| | - Yu-Jun Chang
- Laboratory of Epidemiology and Biostastics, Changhua Christian Hospital, Changhua, Taiwan
| | - Chun-Yu Chen
- Department of Emergency Medicine, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
| | - Wen-Ya Lin
- Department of Pediatric Emergency Medicine, Department of Pediatrics, Taichung Veteran General Hospital, Taichung, Taiwan
| | - Han-Ping Wu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd, Puzi City, Taiwan.
| |
Collapse
|
9
|
Inai K, Higuchi S, Shimada A, Hisada K, Hida Y, Hatta S, Kitano F, Uno M, Matsukawa H, Noriki S, Iwasaki H, Naiki H. Exploration of sepsis assisting parameters in hospital autopsied-patients: a prospective study. Sci Rep 2023; 13:10681. [PMID: 37393368 PMCID: PMC10314941 DOI: 10.1038/s41598-023-37752-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/27/2023] [Indexed: 07/03/2023] Open
Abstract
Although Sepsis-3 doesn't require evidence of bacteremia to diagnose sepsis, clinicians often want to identify the causative pathogen at autopsy. In principle, if the blood cultures are the same at ante- and postmortem, the cause of death is obvious. However, interpretations of postmortem blood cultures are often difficult due to discordance, negativity, mixed infection, and contamination, of pathogens occupying ≥ 50% of the tests. To increase specificity identifying agonal phase sepsis in the situations where blood cultures are discordant, multiple or negative at postmortem, we established a scoring system using blood cultures, procalcitonin (PCN) showing highest sensitivity and specificity for postmortem serum, and bone marrow polyhemophagocytosis (PHP). Histological sepsis showed significantly higher levels of culture score (2.3 ± 1.5 vs. 0.4 ± 0.5, p < 0.001), PHP score (2.5 ± 0.8 vs. 1.0 ± 1.1, p < 0.001), and PCN score (1.8 ± 0.8 vs. 0.8 ± 0.6, p < 0.01) than non-septic patients. Receiver operating characteristic curve analysis indicated that estimation of three scores was the most reliable indicator for recognizing agonal phase sepsis. These findings suggest that the combination of these three inspections enables to determine the pathological diagnoses of sepsis even it is not obvious by discordant, mixed or negative blood cultures.
Collapse
Affiliation(s)
- Kunihiro Inai
- Division of Molecular Pathology, Department of Pathological Sciences, School of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan.
| | - Shohei Higuchi
- Division of Molecular Pathology, Department of Pathological Sciences, School of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Akihiro Shimada
- Division of Infection Control, University of Fukui Hospital, Fukui, Japan
| | - Kyoko Hisada
- Division of Infection Control, University of Fukui Hospital, Fukui, Japan
| | - Yukio Hida
- Division of Infection Control, University of Fukui Hospital, Fukui, Japan
| | - Satomi Hatta
- Division of Molecular Pathology, Department of Pathological Sciences, School of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Fumihiro Kitano
- Division of Rural Medicine, School of Medical Sciences, University of Fukui, Fukui, Japan
| | - Miyuki Uno
- Department of Pharmacy, University of Fukui Hospital, Fukui, Japan
| | - Haruka Matsukawa
- Division of Molecular Pathology, Department of Pathological Sciences, School of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Sakon Noriki
- Faculty of Nursing and Social Welfare Sciences, Fukui Prefectural University, Fukui, Japan
| | - Hiromichi Iwasaki
- Division of Infection Control, University of Fukui Hospital, Fukui, Japan
| | - Hironobu Naiki
- Division of Molecular Pathology, Department of Pathological Sciences, School of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| |
Collapse
|
10
|
Capossela L, Margiotta G, Ferretti S, Curatola A, Bertolaso C, Pansini V, Di Sarno L, Gatto A. Presepsin as a diagnostic marker of sepsis in children and adolescents: a short critical update. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023062. [PMID: 37326282 PMCID: PMC10308464 DOI: 10.23750/abm.v94i3.13358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 01/16/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND AIM Sepsis is a potentially fatal condition which strikes 1.2 million children worldwide per year. New biomarkers have been proposed in the assessment of the risk of sepsis progression and in the identification of patients with the worst outcome. This review aims to assess the diagnostic value of presepsin, a promising new biomarker, in pediatric sepsis, with particular attention to its usefulness in emergency department. METHODS We performed a literature search of the last 10 years to find presepsin related studies and reports concerning pediatric population aged from 0 months to 18 years. We mainly focused on randomized placebo-control studies, followed by case-control studies, observational (both retrospective or prospective), and finally systematic reviews and meta-analysis. The article selection process was carried out independently by three reviewers. Results: A total of 60 records were identified in literature, 49 were excluded according to the exclusion criteria. The highest presepsin sensitivity value was 100%, with a high cut-off (800.5 pg/mL). The highest sensitivity-specificity ratio was 94% vs 100%, with a similar considered presepsin cut-off (855 ng/L). As regards the presepsin cut-offs reported in the various studies, several authors agree on a critical threshold of about 650 ng/L to guarantee a sensitivity> 90%. The analyzed studies show a wide variability for patients' age and presepsin risk cut-offs. Conclusions: Presepsin seems to be a new useful marker for early diagnosis of sepsis, even in a pediatric emergency setting. Being a new marker of sepsis, more studies are required to better understand its potential.
Collapse
Affiliation(s)
- Lavinia Capossela
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Gaia Margiotta
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Serena Ferretti
- a:1:{s:5:"en_US";s:114:"Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy ";}.
| | - Antonietta Curatola
- Department of Pediatrics, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Rome, Italy.
| | - Chiara Bertolaso
- Pediatric Intensive Care Unit, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Rome, Italy.
| | | | - Lorenzo Di Sarno
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Antonio Gatto
- Department of Pediatrics, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Rome, Italy.
| |
Collapse
|
11
|
Sara C, Davide L, Nunzia L, Tamara B, Luca P, Daniele Z, Marcello L, Arcangelo P, Riccardo M. The role of presepsin in pediatric patients with oncological and hematological diseases experiencing febrile neutropenia. Sci Rep 2023; 13:6464. [PMID: 37081067 PMCID: PMC10119114 DOI: 10.1038/s41598-023-33094-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/06/2023] [Indexed: 04/22/2023] Open
Abstract
Febrile neutropenia (FN) represents one of the main complications of pediatric patients with oncological and hematological diseases. In these patients, it is crucial to identify bacterial infections. The aim of this study is to evaluate presepsin as an early biomarker of bacterial infections during FN. We compared patients with oncological and hematological diseases and a 2:1 age-matched healthy control group. In the FN group, we evaluated 4 biomarkers, namely, C reactive protein (CRP), procalcitonin (PCT), interleukin 6 (IL6) and presepsin at the onset of fever (T0) and 48 h after T0 (T1). In the control group, we only evaluated presepsin. We enrolled a total of 41 children with oncological and hematological diseases disease experiencing 50 FN episodes and 100 healthy patients in the control group. In patients with FN, we found that presepsin was significantly higher than in the control group (p < 0.001). However, in the FN group, we did not find a statistically significant difference between patients with and without bacteremia (p = 0.989 at T0, p = 0.619 at T1). Presepsin values at T1 were higher in patients experiencing an unfavorable outcome (p = 0.025). This study shows that presepsin increases in neutropenic patients, but it only revealed useful in predicting an unfavorable outcome 48 h from the onset of fever.
Collapse
Affiliation(s)
- Cerasi Sara
- Pediatric Oncology and Hematology "Lalla Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti 11, 40138, Bologna, Italy
| | - Leardini Davide
- Pediatric Oncology and Hematology "Lalla Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti 11, 40138, Bologna, Italy.
| | - Lisanti Nunzia
- Pediatric Oncology and Hematology "Lalla Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti 11, 40138, Bologna, Italy
| | - Belotti Tamara
- Pediatric Oncology and Hematology "Lalla Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti 11, 40138, Bologna, Italy
| | - Pierantoni Luca
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Zama Daniele
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Lanari Marcello
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Prete Arcangelo
- Pediatric Oncology and Hematology "Lalla Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti 11, 40138, Bologna, Italy
| | - Masetti Riccardo
- Pediatric Oncology and Hematology "Lalla Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti 11, 40138, Bologna, Italy
| |
Collapse
|
12
|
Roy S, Kothari N, Sharma P, Sharma A, Goyal S, Sankanagoudar S, Bhatia PK. Comparison of Diagnostic Accuracy of Presepsin and Procalcitonin for Sepsis in Critically Ill Patients: A Prospective Observational Study. Indian J Crit Care Med 2023. [DOI: 10.5005/jp-journals-10071-24439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
|
13
|
Puspaningtyas NW, Karyanti MR, Paramita TN, Sjakti HA, Putri ND, Tridjaja B, Yanuarso PB, Rinaldhy K, Yani A, Gayatri P. Presepsin as a promising biomarker for early detection of post-operative infection in children. Front Pediatr 2023; 11:1036993. [PMID: 36994432 PMCID: PMC10040647 DOI: 10.3389/fped.2023.1036993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/23/2023] [Indexed: 03/31/2023] Open
Abstract
Background Post-operative systemic inflammation response syndrome (SIRS) is an event that results from surgical trauma, white blood cells contact activation, and intra-surgical bacterial translocation, which is difficult to distinguish from sepsis. Presepsin is a novel biomarker that is increased since the early stages of bacterial infection and can be used to confirm the diagnosis of post-operative infectious complications. This study aimed to investigate the diagnostic performance of presepsin for post-operative infectious complications compared to other well-known biomarkers. Method This cross-sectional study included 100 post-operative patients admitted to Cipto Mangunkusumo National Hospital and Bunda Hospital in Jakarta, Indonesia. The objective was to identify the optimal cutoff and trend of plasma presepsin concentration on the first and third day after surgery and to compare them with other biomarkers. Result Plasma presepsin level was higher in the infection group compared to the non-infection group (median 806.5 pg/ml vs. 717 pg/ml and 980 pg/ml vs. 516 pg/ml on the first and third day, respectively). Presepsin levels tended to increase on the third post-operative day (median + 252 pg/ml) in children with infection. The opposite trend was observed in the non-infection group from the first to the third day (median -222.5 pg/ml). Presepsin delta, a three-day difference between the first and third post-operative day, had the best diagnostic performance compared to other biomarkers (Area Under the Curve 0.825). The optimal cutoff for presepsin delta to diagnose post-operative infection was +90.5 pg/ml. Conclusion Serial assessments of presepsin levels on the first and third days post-surgery and their trends are helpful diagnostic markers for clinicians to detect post-operative infectious complications in children.
Collapse
Affiliation(s)
- Niken Wahyu Puspaningtyas
- Department of Pediatrics, Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Mulya Rahma Karyanti
- Department of Pediatrics, Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Tiara Nien Paramita
- Department of Pediatrics, Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Correspondence: Tiara Nien Paramita
| | - Hikari Ambara Sjakti
- Department of Pediatrics, Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nina Dwi Putri
- Department of Pediatrics, Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Bambang Tridjaja
- Department of Pediatrics, Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Piprim Basarah Yanuarso
- Department of Pediatrics, Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Kshetra Rinaldhy
- Department of Surgery, Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ahmad Yani
- Department of Surgery, Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Pramita Gayatri
- Department of Pediatrics, Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| |
Collapse
|
14
|
Khera D, Toteja N, Singh S, Didel S, Singh K, Chugh A, Singh S. The Role of Presepsin as a Biomarker of Sepsis in Children: A Systemic Review and Meta-Analysis. J Pediatr Intensive Care 2022. [DOI: 10.1055/s-0042-1758479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Objectives Biomarkers in sepsis are an arena of avid research as they can facilitate timely diagnosis and help reduce mortality. Presepsin is a promising candidate with good diagnostic performance reported in adult and neonatal studies. However, there is no clear consensus about its utility in the pediatric age group. This study aimed to synthesize scientific evidence regarding the diagnostic and prognostic performance of presepsin in pediatric sepsis.
Data Sources A systematic literature search was conducted in MEDLINE/PubMed, Cochrane Central Register of Clinical Trials, Google Scholar, and Scopus to identify relevant studies reporting the diagnostic and prognostic accuracy of presepsin.
Study Selection Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we retrieved all controlled trials and observational studies on presepsin as a biomarker in children aged <19 years with sepsis.
Data Extraction Two authors independently performed study screening, data extraction, and quality assessment of the included studies.
Data Synthesis Among the 267 citations identified, a total of nine relevant studies were included in the final analysis. The pooled diagnostic sensitivity and specificity of presepsin were 0.99 (95% confidence interval [CI]; 0.97–1.00) and 0.88 (95% CI; 0.83–0.92), respectively, with a diagnostic odds ratio (DOR) of 28.15 (95% CI; 0.74–1065.67) and area under the curve (AUC) in summary receiver operating curve of 0.89. Prognostic accuracy for presepsin had a sensitivity of 0.64 (95% CI; 0.35–1.0), specificity of 0.62 (95% CI; 0.44–0.87), and DOR of 3.3 (95% CI; 0.20–53.43). For procalcitonin, the pooled sensitivity for diagnostic accuracy was 0.97 (95% CI; 0.94–1.00), specificity was 0.76 (95% CI; 0.69–0.82), DOR was 10.53 (95% CI; 5.31–20.88), and AUC was 0.81.
Conclusion Presepsin has good diagnostic accuracy with high sensitivity and specificity. Its prognostic accuracy in predicting mortality is low.
Collapse
Affiliation(s)
- Daisy Khera
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Nisha Toteja
- Department of Paediatrics, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Simranjeet Singh
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Siyaram Didel
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kuldeep Singh
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ankita Chugh
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Surjit Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| |
Collapse
|
15
|
Khera D, Toteja N, Singh S, Singh S, Kumar P, Sharma P, Singh K. Is There a Role of Presepsin as a Novel Biomarker in Pediatric Sepsis? Indian J Crit Care Med 2022; 26:712-716. [PMID: 35836633 PMCID: PMC9237156 DOI: 10.5005/jp-journals-10071-24202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Daisy Khera
- Department of Pediatrics, AIIMS, Jodhpur, Rajasthan, India
| | - Nisha Toteja
- Department of Pediatrics, AIIMS, Gorakhpur, Uttar Pradesh, India
- Nisha Toteja, Department of Pediatrics, AIIMS, Gorakhpur, Uttar Pradesh, India, Phone: + 91 9873245575, e-mail:
| | - Surjit Singh
- Department of Pharmacology, AIIMS, Jodhpur, Rajasthan, India
| | | | - Prawin Kumar
- Department of Pediatrics, AIIMS, Jodhpur, Rajasthan, India
| | - Praveen Sharma
- Department of Biochemistry, AIIMS, Jodhpur, Rajasthan, India
| | - Kuldeep Singh
- Department of Pediatrics, AIIMS, Jodhpur, Rajasthan, India
| |
Collapse
|
16
|
Samprathi A, Samprathi M, Reddy M. Presepsin: Hope in the Quest for the Holy Grail. Indian J Crit Care Med 2022; 26:664-666. [PMID: 35836630 PMCID: PMC9237159 DOI: 10.5005/jp-journals-10071-24251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
How to cite this article: Samprathi A, Samprathi M, Reddy M. Presepsin: Hope in the Quest for the Holy Grail. Indian J Crit Care Med 2022;26(6):664–666.
Collapse
Affiliation(s)
- Abhishek Samprathi
- Department of Critical Care Medicine, Fortis Hospitals, Bengaluru, Karnataka, India
| | - Madhusudan Samprathi
- Department of Pediatrics, All India Institute of Medical Sciences, Hyderabad, Telangana, India
- Madhusudan Samprathi, Department of Pediatrics, All India Institute of Medical Sciences, Hyderabad, Telangana, India, Phone: +91 7077703235, e-mail:
| | - Mounika Reddy
- Department of Pediatrics, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| |
Collapse
|
17
|
Güleç RD, Arslan FD, Çalışkan T, Şenol N, Yılmaz N, Atalay S, Pirim İ. Could presepsin be an alternative marker in the early diagnosis of sepsis in COVID-19? Scandinavian Journal of Clinical and Laboratory Investigation 2022; 82:108-114. [DOI: 10.1080/00365513.2022.2031278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Rasime Derya Güleç
- Department of Tissue Typing Laboratory, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Fatma Demet Arslan
- Department of Medical Biochemistry, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Taner Çalışkan
- Department of Anesthesia and Reanimation, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Nimet Şenol
- Department of Anesthesia and Reanimation, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Nisel Yılmaz
- Department of Medical Microbiology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Sabri Atalay
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - İbrahim Pirim
- Department of Medical Biology, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| |
Collapse
|
18
|
Dewan M. Use of Procalcitonin in Pediatric Sepsis is Low-Value Care. J Pediatric Infect Dis Soc 2022; 11:31-32. [PMID: 34338798 DOI: 10.1093/jpids/piab068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/11/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Maya Dewan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| |
Collapse
|
19
|
Ozger H, Senol E. Use of infection biomarkers in the emergency department. Turk J Emerg Med 2022; 22:169-176. [PMID: 36353385 PMCID: PMC9639740 DOI: 10.4103/2452-2473.357347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
The use of infection biomarkers in the emergency department is discussed in terms of their possible contributions to diagnostic-prognostic uncertainties, appropriate antibiotic treatments, and triage and follow-up planning. Procalcitonin (PCT), C-reactive protein (CRP), proadrenomedullin (proADM), and presepsin are among the most discussed infection biomarkers for use in the emergency department. Due to the variable sensitivity results and cutoff values, there are insufficient data to recommend the widespread use of CRP and procalcitonin (PCT) for the diagnosis and prognosis of infection in the emergency department. However, these biomarkers can be used for appropriate antibiotic use in selected infection groups, such as community-acquired pneumonia, especially to reduce unnecessary antibiotic prescribing. With its prognostic superiority over other biomarkers and its contribution to prognostic score systems in community-acquired pneumonia (CAP), proADM can be used to predict hospitalization, preferably within the scope of clinical studies. Although presepsin has been shown to have some advantages over other biomarkers to rule out sepsis, there are insufficient data for its clinical use in the emergency department.
Collapse
|
20
|
Maddaloni C, De Rose DU, Santisi A, Martini L, Caoci S, Bersani I, Ronchetti MP, Auriti C. The Emerging Role of Presepsin (P-SEP) in the Diagnosis of Sepsis in the Critically Ill Infant: A Literature Review. Int J Mol Sci 2021; 22:ijms222212154. [PMID: 34830040 PMCID: PMC8620326 DOI: 10.3390/ijms222212154] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 12/11/2022] Open
Abstract
Sepsis causes high rates of morbidity and mortality in NICUs. The estimated incidence varies between 5 and 170 per 1000 births, depending on the social context. In very low birth-weight neonates, the level of mortality increases with the duration of hospitalization, reaching 36% among infants aged 8-14 days and 52% among infants aged 15-28 days. Early diagnosis is the only tool to improve the poor prognosis of neonatal sepsis. Blood culture, the gold standard for diagnosis, is time-consuming and poorly sensitive. C-reactive protein and procalcitonin, currently used as sepsis biomarkers, are influenced by several maternal and fetal pro-inflammatory conditions in the perinatal age. Presepsin is the N-terminal fragment of soluble CD14 subtype (sCD14-ST): it is released in the bloodstream by monocytes and macrophages, in response to bacterial invasion. Presepsin seems to be a new, promising biomarker for the early diagnosis of sepsis in neonates as it is not modified by perinatal confounding inflammatory factors. The aim of the present review is to collect current knowledge about the role of presepsin in critically ill neonates.
Collapse
Affiliation(s)
- Chiara Maddaloni
- Neonatal Intensive Care Unit (NICU), Medical and Surgical Department of the Fetus—Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (C.M.); (D.U.D.R.); (A.S.); (L.M.); (S.C.); (I.B.); (M.P.R.)
| | - Domenico Umberto De Rose
- Neonatal Intensive Care Unit (NICU), Medical and Surgical Department of the Fetus—Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (C.M.); (D.U.D.R.); (A.S.); (L.M.); (S.C.); (I.B.); (M.P.R.)
| | - Alessandra Santisi
- Neonatal Intensive Care Unit (NICU), Medical and Surgical Department of the Fetus—Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (C.M.); (D.U.D.R.); (A.S.); (L.M.); (S.C.); (I.B.); (M.P.R.)
| | - Ludovica Martini
- Neonatal Intensive Care Unit (NICU), Medical and Surgical Department of the Fetus—Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (C.M.); (D.U.D.R.); (A.S.); (L.M.); (S.C.); (I.B.); (M.P.R.)
| | - Stefano Caoci
- Neonatal Intensive Care Unit (NICU), Medical and Surgical Department of the Fetus—Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (C.M.); (D.U.D.R.); (A.S.); (L.M.); (S.C.); (I.B.); (M.P.R.)
| | - Iliana Bersani
- Neonatal Intensive Care Unit (NICU), Medical and Surgical Department of the Fetus—Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (C.M.); (D.U.D.R.); (A.S.); (L.M.); (S.C.); (I.B.); (M.P.R.)
| | - Maria Paola Ronchetti
- Neonatal Intensive Care Unit (NICU), Medical and Surgical Department of the Fetus—Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (C.M.); (D.U.D.R.); (A.S.); (L.M.); (S.C.); (I.B.); (M.P.R.)
- Neonatal Intensive Care (NICU) and Neonatal Pathology, San Vincenzo Hospital, 98039 Taormina, Italy
| | - Cinzia Auriti
- Neonatal Intensive Care Unit (NICU), Medical and Surgical Department of the Fetus—Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (C.M.); (D.U.D.R.); (A.S.); (L.M.); (S.C.); (I.B.); (M.P.R.)
- Correspondence: ; Tel.: +39-06-6859-2427; Fax: +39-06-6859-3916
| |
Collapse
|
21
|
Hassuna NA, Elgezawy E, Mousa SO, AbdelAziz RA, Ibrahem RA, Wahed WYA, Nasif KA, Hefzy EM. Diagnostic value of monocyte chemoattractant Protein-1, soluble mannose receptor, Presepsin, and Procalcitonin in critically ill children admitted with suspected sepsis. BMC Pediatr 2021; 21:458. [PMID: 34666725 PMCID: PMC8524917 DOI: 10.1186/s12887-021-02930-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/06/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction The differentiation between systemic inflammatory response syndrome and sepsis is very important as it determines essential treatment decisions, such as selection, initiation, and duration of antibiotic therapy. Objectives We aimed to investigate the diagnostic value of Procalcitonin, Monocyte Chemoattractant Protein-1, soluble Mannose Receptor, Presepsin as early biomarkers of pediatric sepsis in comparison to systemic inflammatory response syndrome in severely ill children. Patients and methods This study included 58 children diagnosed as sepsis (group 1), 24 children with systemic inflammatory response syndrome without infection (group 2), and 50 healthy children as controls (group 3). All the plasma levels of the studied biomarkers were measured and ROC curves were created for all the tested parameters to discriminate between sepsis and SIRS. Results The area under the curve for Monocyte Chemoattractant Protein-1 was 0.926 (0.846-0.927) with sensitivity 100% and specificity 62.5%. The soluble Mannose Receptor had the highest sensitivity (100%), with AUC equals 1(.0.956-1.0) and specificity of 100%. The cut-off values for Procalcitonin, Presepsin, soluble Mannose Receptor, and Monocyte Chemoattractant Protein-1 and were: 0.62 ng/ml, 100 pg/ml, 13 ng/ml and 90 pg/ml, respectively. In septic cases, both soluble Mannose Receptor and Procalcitonin have positive correlations with the severity of sepsis, low Glasgow Coma Scale, ventilatory support, use of inotropic drugs and mortality rate (r = 0.950, 0.812, 0.795, 0.732 and 0.861respectively) for soluble Mannose Receptor and (0.536, 0.473, 0.422, 0.305 and 0.474 respectively) for Procalcitonin. Conclusion Soluble Mannose Receptor, Presepsin, and Monocyte Chemoattractant Protein-1 can be used to differentiate between sepsis and SIRS in critically ill children.
Collapse
Affiliation(s)
- Noha A Hassuna
- Medical Microbiology and Immunology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ebtesam Elgezawy
- Clinical Pathology Department, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Suzan O Mousa
- Pediatrics Department, Faculty of Medicine, Minia University, Minia, 61111, Egypt
| | - Reem A AbdelAziz
- Pediatrics Department, Faculty of Medicine, Minia University, Minia, 61111, Egypt.
| | - Reham A Ibrahem
- Microbiology and Immunology, Faculty of Pharmacy, Minia University, Minia, Egypt
| | | | - Khalid A Nasif
- Biochemistry Department, Faculty of Medicine, Minia University, Minia, Egypt.,Clinical Biochemistry, Faculty of Medicine, King Khaled University, Abha, Saudi Arabia
| | - Enas M Hefzy
- Medical Microbiology and Immunology Department Faculty of Medicine, Fayoum University, Faiyum, Egypt
| |
Collapse
|
22
|
Abstract
PURPOSE The proteome during lipopolysaccharide (LPS)-induced acute lung injury (ALI) in mice is unclear. MATERIALS AND METHODS In this study, eight-week-old male C57BL/6 mice were intraperitoneally injected with LPS and sacrificed 18 hours after LPS administration to identify protein expression levels in lung tissue using tandem mass tag (TMT) analysis for relative quantification. Hematoxylin-eosin (HE) staining was used to evaluate lung injury in mice. Immunohistochemical staining was used to calculate the production of myeloperoxidase (MPO) and TUNEL staining was performed to detect apoptosis. GO functional clustering and KEGG pathway enrichment analyses were performed to determine functions of differentially expressed proteins (DEPs) and transduction pathways. Domain annotation and subcellular localization analysis of the DEPs were also performed. Furthermore, parallel reaction monitoring (PRM) analysis was used to verify the top 30 DEPs. RESULTS A total of 5188 proteins were found to be expressed in lung tissues from LPS- and saline-treated mice. Among these proteins, 293 were differentially expressed between the two groups; 255 proteins were upregulated in the LPS-treated ALI mice, while 38 were downregulated. GO analysis showed that the DEPs are mainly extracellular, and KEGG analysis suggested that the DEPs are mainly enriched in the NOD-like receptor signaling pathway, complement and coagulation cascades and natural killer cell-mediated cytotoxicity. Enrichment of the DEPs is mainly peptidase S1A, serine proteases, peptidase S1, and the serpin domain. 26.6% of the DEPs are in the nucleus, 24.6% are in the cytosol, 19.1% are in the extracellular space, and 18.8% are in the plasma membrane. PRM validation showed that the trend of 30 DEPs was same with TMT analysis. Among these, Cytochrome b-245 heavy chain (Cybb), Monocyte differentiation antigen CD14 (Cd14) and Neutrophil gelatinase-associated lipocalin (NGAL) were the most obvious change. CONCLUSIONS Our results may help to identify markers and therapeutic targets for LPS-induced ALI.
Collapse
Affiliation(s)
- Shengsong Chen
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, P. R. China.,Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P. R. China.,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, Beijing, P. R. China.,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing , P. R. China.,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing, P. R. China.,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, P. R. China
| | - Yi Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, P. R. China.,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, Beijing, P. R. China.,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing , P. R. China.,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing, P. R. China.,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, P. R. China
| | - Qingyuan Zhan
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, P. R. China.,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, Beijing, P. R. China.,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing , P. R. China.,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing, P. R. China.,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, P. R. China
| |
Collapse
|
23
|
Downes KJ. Procalcitonin in Pediatric Sepsis: What Is It Good for? J Pediatric Infect Dis Soc 2021; 10:1108-1110. [PMID: 34329449 PMCID: PMC8719609 DOI: 10.1093/jpids/piab066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 11/14/2022]
Abstract
Procalcitonin has several advantages over traditional biomarkers in the management of pediatric sepsis. In combination with other clinical/laboratory data or measured over time, procalcitonin can support earlier antibiotic discontinuations and reduce unnecessary antibiotic use.
Collapse
Affiliation(s)
- Kevin J Downes
- Division of Infectious, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Center for Clinical Pharmacology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA,Corresponding Author: Kevin J. Downes, MD, Roberts Center for Pediatric Research, Children’s Hospital of Philadelphia, 2716 South Street, Suite 10360, Philadelphia, PA 19146, USA. E-mail:
| |
Collapse
|
24
|
Piccioni A, Santoro MC, de Cunzo T, Tullo G, Cicchinelli S, Saviano A, Valletta F, Pascale MM, Candelli M, Covino M, Franceschi F. Presepsin as Early Marker of Sepsis in Emergency Department: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57080770. [PMID: 34440976 PMCID: PMC8398764 DOI: 10.3390/medicina57080770] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 02/05/2023]
Abstract
The diagnosis and treatment of sepsis have always been a challenge for the physician, especially in critical care setting such as emergency department (ED), and currently sepsis remains one of the major causes of mortality. Although the traditional definition of sepsis based on systemic inflammatory response syndrome (SIRS) criteria changed in 2016, replaced by the new criteria of SEPSIS-3 based on organ failure evaluation, early identification and consequent early appropriated therapy remain the primary goal of sepsis treatment. Unfortunately, currently there is a lack of a foolproof system for making early sepsis diagnosis because conventional diagnostic tools like cultures take a long time and are often burdened with false negatives, while molecular techniques require specific equipment and have high costs. In this context, biomarkers, such as C-Reactive Protein (CRP) and Procalcitonin (PCT), are very useful tools to distinguish between normal and pathological conditions, graduate the disease severity, guide treatment, monitor therapeutic responses and predict prognosis. Among the new emerging biomarkers of sepsis, Presepsin (P-SEP) appears to be the most promising. Several studies have shown that P-SEP plasma levels increase during bacterial sepsis and decline in response to appropriate therapy, with sensitivity and specificity values comparable to those of PCT. In neonatal sepsis, P-SEP compared to PCT has been shown to be more effective in diagnosing and guiding therapy. Since in sepsis the P-SEP plasma levels increase before those of PCT and since the current methods available allow measurement of P-SEP plasma levels within 17 min, P-SEP appears a sepsis biomarker particularly suited to the emergency department and critical care.
Collapse
Affiliation(s)
- Andrea Piccioni
- Emergency Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.P.); (S.C.); (M.M.P.); (M.C.); (M.C.); (F.F.)
| | - Michele Cosimo Santoro
- Emergency Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.P.); (S.C.); (M.M.P.); (M.C.); (M.C.); (F.F.)
- Correspondence:
| | - Tommaso de Cunzo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (T.d.C.); (G.T.); (A.S.); (F.V.)
| | - Gianluca Tullo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (T.d.C.); (G.T.); (A.S.); (F.V.)
| | - Sara Cicchinelli
- Emergency Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.P.); (S.C.); (M.M.P.); (M.C.); (M.C.); (F.F.)
| | - Angela Saviano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (T.d.C.); (G.T.); (A.S.); (F.V.)
| | - Federico Valletta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (T.d.C.); (G.T.); (A.S.); (F.V.)
| | - Marco Maria Pascale
- Emergency Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.P.); (S.C.); (M.M.P.); (M.C.); (M.C.); (F.F.)
| | - Marcello Candelli
- Emergency Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.P.); (S.C.); (M.M.P.); (M.C.); (M.C.); (F.F.)
| | - Marcello Covino
- Emergency Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.P.); (S.C.); (M.M.P.); (M.C.); (M.C.); (F.F.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (T.d.C.); (G.T.); (A.S.); (F.V.)
| | - Francesco Franceschi
- Emergency Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.P.); (S.C.); (M.M.P.); (M.C.); (M.C.); (F.F.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (T.d.C.); (G.T.); (A.S.); (F.V.)
| |
Collapse
|
25
|
Zheng G, Zhang C, Zhang G, Shao C. Evaluation of the Diagnostic and Prognostic Value of CSF Presepsin Levels in Patients with Postneurosurgical Ventriculitis/Meningitis. Infect Drug Resist 2021; 14:2901-2909. [PMID: 34349525 PMCID: PMC8326282 DOI: 10.2147/idr.s325635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 07/20/2021] [Indexed: 01/11/2023] Open
Abstract
Aim To evaluate the diagnostic and prognostic value of CSF presepsin levels in patients with postneurosurgical ventriculitis/meningitis (PNVM). Methods We conducted a case-control study to achieve our aims. First, we prospectively enrolled patients who had undergone neurosurgery in Beijing Tiantan Hospital from June to November 2020 and measured the CSF levels of 8 biomarkers, including presepsin and other meningitis biomarkers. The diagnostic and prognostic accuracies of presepsin levels were evaluated by determining the values for the area under the receiver operating characteristic curve (AUC). Results Two hundred thirty-nine patients were enrolled in this study; 34 were diagnosed with confirmed ventriculitis/meningitis (cVM), 138 were classified as probable ventriculitis/meningitis (pVM), and the others were rejected ventriculitis/meningitis (rVM). Presepsin levels effectively diagnose cVM and predict the outcomes of patients with PNVM, with thresholds of 1257.4 pg/mL and 1276.2 pg/mL and AUCs of 0.746 and 0.825, respectively. Furthermore, a joint analysis with CSF lactate (C-Lac) levels shows that the AUCs of the two markers increased to 0.856 and 0.872, respectively. Conclusion The rapid diagnosis and prediction of the clinical outcome is important in neurosurgery. CSF presepsin levels are an impressive diagnostic and prognostic biomarker for meningitis, and when combined with C-Lac, they indeed improve the diagnostic and predictive efficiency of PNVM.
Collapse
Affiliation(s)
- Guanghui Zheng
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital and Capital Medical University, Beijing, People's Republic of China.,NMPA Key Laboratory for Quality Control of in vitro Diagnostics, National Medical Products Administration, Beijing, People's Republic of China.,Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing Municipal Science and Technology Commission, Beijing, People's Republic of China
| | - Chenxi Zhang
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital and Capital Medical University, Beijing, People's Republic of China.,NMPA Key Laboratory for Quality Control of in vitro Diagnostics, National Medical Products Administration, Beijing, People's Republic of China.,Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing Municipal Science and Technology Commission, Beijing, People's Republic of China
| | - Guojun Zhang
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital and Capital Medical University, Beijing, People's Republic of China.,NMPA Key Laboratory for Quality Control of in vitro Diagnostics, National Medical Products Administration, Beijing, People's Republic of China.,Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing Municipal Science and Technology Commission, Beijing, People's Republic of China
| | - Chunqing Shao
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital and Capital Medical University, Beijing, People's Republic of China.,NMPA Key Laboratory for Quality Control of in vitro Diagnostics, National Medical Products Administration, Beijing, People's Republic of China.,Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing Municipal Science and Technology Commission, Beijing, People's Republic of China
| |
Collapse
|
26
|
Zandstra J, Jongerius I, Kuijpers TW. Future Biomarkers for Infection and Inflammation in Febrile Children. Front Immunol 2021; 12:631308. [PMID: 34079538 PMCID: PMC8165271 DOI: 10.3389/fimmu.2021.631308] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/12/2021] [Indexed: 01/08/2023] Open
Abstract
Febrile patients, suffering from an infection, inflammatory disease or autoimmunity may present with similar or overlapping clinical symptoms, which makes early diagnosis difficult. Therefore, biomarkers are needed to help physicians form a correct diagnosis and initiate the right treatment to improve patient outcomes following first presentation or admittance to hospital. Here, we review the landscape of novel biomarkers and approaches of biomarker discovery. We first discuss the use of current plasma parameters and whole blood biomarkers, including results obtained by RNA profiling and mass spectrometry, to discriminate between bacterial and viral infections. Next we expand upon the use of biomarkers to distinguish between infectious and non-infectious disease. Finally, we discuss the strengths as well as the potential pitfalls of current developments. We conclude that the use of combination tests, using either protein markers or transcriptomic analysis, have advanced considerably and should be further explored to improve current diagnostics regarding febrile infections and inflammation. If proven effective when combined, these biomarker signatures will greatly accelerate early and tailored treatment decisions.
Collapse
Affiliation(s)
- Judith Zandstra
- Division Research and Landsteiner Laboratory, Department of Immunopathology, Sanquin Blood Supply, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children’s Hospital, Amsterdam UMC, Amsterdam, Netherlands
| | - Ilse Jongerius
- Division Research and Landsteiner Laboratory, Department of Immunopathology, Sanquin Blood Supply, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children’s Hospital, Amsterdam UMC, Amsterdam, Netherlands
| | - Taco W. Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children’s Hospital, Amsterdam UMC, Amsterdam, Netherlands
- Division Research and Landsteiner Laboratory, Department of Blood Cell Research, Sanquin Blood Supply, Amsterdam UMC, Amsterdam, Netherlands
| |
Collapse
|
27
|
Zheng H, Glauser J. Review and Updates on Pediatric Fever. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2021. [DOI: 10.1007/s40138-021-00227-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
28
|
Yin F, Xi YL, Wang Y, Li BR, Qian J, Ren H, Zhang J, Tang HZ, Ning BT. The clinical outcomes and biomarker features of severe sepsis/septic shock with severe neutropenia: a retrospective cohort study. Transl Pediatr 2021; 10:464-473. [PMID: 33850805 PMCID: PMC8039791 DOI: 10.21037/tp-20-230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Severe sepsis/septic shock with severe neutropenia often leads to poor prognosis. However, it is unknown if severe neutropenia is associated with different clinical outcomes and biomarker features in severe sepsis/septic patients. METHODS This retrospective cohort study enrolled 141 severe sepsis/septic shock patients admitted to intensive care unit of Shanghai Children's Medical Center between January 2015 and November 2019. Patients were followed up for the development of ventilation support, the use of vasoactive drugs, continuous renal replacement therapy (CRRT) procedure, and mortality. Biomarkers that reflect the level of inflammation in severe sepsis/septic shock patients with neutropenia were compared to that in patients without neutropenia. RESULTS Of 141 patients enrolled, 54 patients suffered from severe sepsis/septic shock with severe neutropenia. In patients with severe sepsis/septic shock, severe neutropenia as a complication was an independent risk factor for the use of vasoactive drugs (RR 9.796; 95% CI: 3.774, 25.429; P<0.001), but not for ventilation support (RR 0.157; 95% CI: 0.06, 0.414; P<0.001), CRRT procedure (RR 1.032; 95% CI: 0.359, 2.969; P=0.953) or 28-day mortality (RR 1.405; 95% CI: 0.533, 3.708; P=0.492). Severe sepsis/septic patients with severe neutropenia had a higher plasma level of the following biomarkers: c-reaction protein (CRP) (180.5 vs. 121 mg/mL, P<0.001), procalcitonin (PCT) (12.15 vs. 2.7 ng/mL; P=0.005), interleukin (IL)-6 (316.83 vs. 55.77 pg/mL, P<0.001), IL-10 (39.165 vs. 10.09 pg/mL, P<0.001), interferon (IFN)-γ (6.155 vs. 3.71 pg/mL, P=0.016), and the percentage of regulatory T cells (Tregs) (2.7% vs. 2.09%, P=0.003). Based on the receiver operating characteristic curves, IL-10 exhibited high specificity (79.4%) in evaluating the prognosis of septic patients with neutropenia. CONCLUSIONS In patients with severe sepsis/septic shock, being complicated with severe neutropenia is associated with higher proportion of using vasoactive drugs, and those patients tend to have higher plasma levels of IL-6, IL-10, IFN-γ and percentage of Treg.
Collapse
Affiliation(s)
- Fan Yin
- Department of Pediatric Intensive Care Unit, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yue-Ling Xi
- Department of Pediatric Intensive Care Unit, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Wang
- Department of Pediatric Intensive Care Unit, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bi-Ru Li
- Department of Pediatric Intensive Care Unit, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Juan Qian
- Department of Pediatric Intensive Care Unit, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hong Ren
- Department of Pediatric Intensive Care Unit, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Zhang
- Department of Pediatric Intensive Care Unit, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hong-Zhi Tang
- Department of State Key Laboratory of Microbial Metabolism, and School of Life Sciences & Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Bo-Tao Ning
- Department of Pediatric Intensive Care Unit, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
29
|
Zhang P, Zou B, Liou YC, Huang C. The pathogenesis and diagnosis of sepsis post burn injury. BURNS & TRAUMA 2021; 9:tkaa047. [PMID: 33654698 PMCID: PMC7901709 DOI: 10.1093/burnst/tkaa047] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/20/2020] [Indexed: 02/05/2023]
Abstract
Burn is an under-appreciated trauma that is associated with unacceptably high morbidity and mortality. Although the survival rate after devastating burn injuries has continued to increase in previous decades due to medical advances in burn wound care, nutritional and fluid resuscitation and improved infection control practices, there are still large numbers of patients at a high risk of death. One of the most common complications of burn is sepsis, which is defined as “severe organ dysfunction attributed to host's disordered response to infection” and is the primary cause of death in burn patients. Indeed, burn injuries are accompanied by a series of events that lead to sepsis and multiple organ dysfunction syndrome, such as a hypovolaemic state, immune and inflammatory responses and metabolic changes. Therefore, clear diagnostic criteria and predictive biomarkers are especially important in the prevention and treatment of sepsis and septic shock. In this review, we focus on the pathogenesis of burn wound infection and the post-burn events leading to sepsis. Moreover, the clinical and promising biomarkers of burn sepsis will also be summarized.
Collapse
Affiliation(s)
- Pengju Zhang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, No.17 People's South Road, Chengdu, 610041, China
| | - Bingwen Zou
- Department of Thoracic Oncology and Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu, 610041, China
| | - Yih-Cherng Liou
- Department of Biological Sciences, Faculty of Science, National University of Singapore, 14 Science Drive 4, 117543, Singapore
| | - Canhua Huang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, No.17 People's South Road, Chengdu, 610041, China
| |
Collapse
|
30
|
Abstract
Sepsis is the most common cause of mortality in non-cardiac ICUs. The quest for early diagnosis and treatment has led to the discovery of many biomarkers. In this issue, Abdelshafey et al. have evaluated presepsin, a novel biomarker for early detection of sepsis. Presepsin is formed by cleavage of N-terminal of soluble CD14 (sCD14) which is a member of the Toll-like receptors (TLRs). Studies have found a higher level of presepsin in septic patients and values above 946 ng/L correlated well with gram-negative bacterial sepsis. How to cite this article: Azim A. Presepsin: A Promising Biomarker for Sepsis. Indian J Crit Care Med 2021;25(2):117-118.
Collapse
Affiliation(s)
- Afzal Azim
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| |
Collapse
|
31
|
Bulatova YY, Maltabarova NA, Zhumabayev MB, Li TA, Ivanova MP. Modern Diagnostics of Sepsis and Septic Shock in Children. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2020. [DOI: 10.29333/ejgm/7879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
32
|
Biomarkers for Point-of-Care Diagnosis of Sepsis. MICROMACHINES 2020; 11:mi11030286. [PMID: 32164268 PMCID: PMC7143187 DOI: 10.3390/mi11030286] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 12/18/2022]
Abstract
Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. In 2017, almost 50 million cases of sepsis were recorded worldwide and 11 million sepsis-related deaths were reported. Therefore, sepsis is the focus of intense research to better understand the complexities of sepsis response, particularly the twin underlying concepts of an initial hyper-immune response and a counter-immunological state of immunosuppression triggered by an invading pathogen. Diagnosis of sepsis remains a significant challenge. Prompt diagnosis is essential so that treatment can be instigated as early as possible to ensure the best outcome, as delay in treatment is associated with higher mortality. In order to address this diagnostic problem, use of a panel of biomarkers has been proposed as, due to the complexity of the sepsis response, no single marker is sufficient. This review provides background on the current understanding of sepsis in terms of its epidemiology, the evolution of the definition of sepsis, pathobiology and diagnosis and management. Candidate biomarkers of interest and how current and developing point-of-care testing approaches could be used to measure such biomarkers is discussed.
Collapse
|