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Lozano-Vicario L, Muñoz-Vázquez ÁJ, Cedeno-Veloz BA, Romero-Ortuno R, Galbete A, Fernández-Irigoyen J, Santamaría E, Zambom-Ferraresi F, Ortiz-Gómez JR, Hidalgo-Ovejero ÁM, Martínez-Velilla N. The role of C-reactive protein as a risk marker of postoperative delirium in older hip fracture patients: a prospective cohort study. Eur Geriatr Med 2024:10.1007/s41999-024-01046-2. [PMID: 39316273 DOI: 10.1007/s41999-024-01046-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 08/26/2024] [Indexed: 09/25/2024]
Abstract
PURPOSE Postoperative delirium (POD) is a common and serious neuropsychiatric syndrome that leads to higher morbidity and mortality. We investigated the association between serum C-reactive protein (CRP) and the occurrence of POD in older hip fracture patients, and whether CRP predicted POD better than a clinical model. METHODS Patients aged ≥ 75 years admitted for surgical repair of an acute hip fracture were recruited. We compared serum CRP levels between patients with and without POD. RESULTS Sixty patients were included, of whom 21 (35%) developed POD. Serum CRP levels were significantly higher in patients who developed delirium (p = 0.011). In a multiple regression model including clinical variables and CRP, cognitive impairment (p = 0.003) and infection (p = 0.001) were the best predictors of POD. CONCLUSIONS Although higher levels of serum CRP were significantly associated with POD in older hip fracture patients, pre-existing cognitive impairment and infections were the most important risk factors for POD.
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Affiliation(s)
- Lucía Lozano-Vicario
- Department of Geriatric Medicine, Hospital Universitario de Navarra (HUN), Irunlarrea Street 3, 31008, Pamplona, Spain.
| | | | - Bernardo Abel Cedeno-Veloz
- Department of Geriatric Medicine, Hospital Universitario de Navarra (HUN), Irunlarrea Street 3, 31008, Pamplona, Spain
| | - Román Romero-Ortuno
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Arkaitz Galbete
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Joaquín Fernández-Irigoyen
- Proteomics Unit, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain
| | - Enrique Santamaría
- Proteomics Unit, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain
| | - Fabricio Zambom-Ferraresi
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - José Ramón Ortiz-Gómez
- Department of Anesthesiology and Reanimation, Hospital Universitario de Navarra (HUN), Pamplona, Spain
| | | | - Nicolás Martínez-Velilla
- Department of Geriatric Medicine, Hospital Universitario de Navarra (HUN), Irunlarrea Street 3, 31008, Pamplona, Spain
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
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Formenti P, Gotti M, Palmieri F, Pastori S, Roccaforte V, Menozzi A, Galimberti A, Umbrello M, Sabbatini G, Pezzi A. Presepsin in Critical Illness: Current Knowledge and Future Perspectives. Diagnostics (Basel) 2024; 14:1311. [PMID: 38928726 PMCID: PMC11202475 DOI: 10.3390/diagnostics14121311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
The accurate identification of infections is critical for effective treatment in intensive care units (ICUs), yet current diagnostic methods face limitations in sensitivity and specificity, alongside cost and accessibility issues. Consequently, there is a pressing need for a marker that is economically feasible, rapid, and reliable. Presepsin (PSP), also known as soluble CD14 subtype (sCD14-ST), has emerged as a promising biomarker for early sepsis diagnosis. PSP, derived from soluble CD14, reflects the activation of monocytes/macrophages in response to bacterial infections. It has shown potential as a marker of cellular immune response activation against pathogens, with plasma concentrations increasing during bacterial infections and decreasing post-antibiotic treatment. Unlike traditional markers such as procalcitonin (PCT) and C-reactive protein (CRP), PSP specifically indicates monocyte/macrophage activation. Limited studies in critical illness have explored PSP's role in sepsis, and its diagnostic accuracy varies with threshold values, impacting sensitivity and specificity. Recent meta-analyses suggest PSP's diagnostic potential for sepsis, yet its standalone effectiveness in ICU infection management remains uncertain. This review provides a comprehensive overview of PSP's utility in ICU settings, including its diagnostic accuracy, prognostic value, therapeutic implications, challenges, and future directions.
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Affiliation(s)
- Paolo Formenti
- Department of Anesthesia and Intensive Care, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (M.G.); (F.P.); (A.G.); (G.S.); (A.P.)
| | - Miriam Gotti
- Department of Anesthesia and Intensive Care, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (M.G.); (F.P.); (A.G.); (G.S.); (A.P.)
| | - Francesca Palmieri
- Department of Anesthesia and Intensive Care, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (M.G.); (F.P.); (A.G.); (G.S.); (A.P.)
| | - Stefano Pastori
- Department of Clinical Chemistry and Microbiological Analysis, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (S.P.); (V.R.)
| | - Vincenzo Roccaforte
- Department of Clinical Chemistry and Microbiological Analysis, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (S.P.); (V.R.)
| | - Alessandro Menozzi
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy;
| | - Andrea Galimberti
- Department of Anesthesia and Intensive Care, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (M.G.); (F.P.); (A.G.); (G.S.); (A.P.)
| | - Michele Umbrello
- Department of Intensive Care, ASST Ovest Milanese, New Hospital of Legnano, 20025 Legnano, Italy;
| | - Giovanni Sabbatini
- Department of Anesthesia and Intensive Care, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (M.G.); (F.P.); (A.G.); (G.S.); (A.P.)
| | - Angelo Pezzi
- Department of Anesthesia and Intensive Care, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (M.G.); (F.P.); (A.G.); (G.S.); (A.P.)
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Paraskevas T, Chourpiliadi C, Demiri S, Micahilides C, Karanikolas E, Lagadinou M, Velissaris D. Presepsin in the diagnosis of sepsis. Clin Chim Acta 2023; 550:117588. [PMID: 37813329 DOI: 10.1016/j.cca.2023.117588] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES Sepsis is a life-threatening condition characterized by organ dysfunction. It occurs due to the host's dysregulated response to an infection. Clinicians use inflammatory biomarkers to evaluate patients at risk of sepsis in various settings. METHODS We included studies focusing on the diagnostic accuracy of presepsin in patients under suspicion of sepsis. The bivariate model of Reitsma was used for the quantitative synthesis, and summary estimates were calculated. The Zhou-Dendukuri approach was followed to assess heterogeneity. Subgroup analyses were performed based on settings and diagnostic criteria. RESULTS The summary sensitivity for diagnosing sepsis was 0.805 (95 % CI: 0.759-0.844), while the false positive rate (FPR) was 0.174 (95 % CI: 0.124-0.239). The area under the curve (AUC) for the summary receiver operating characteristic (SROC) curve was 0.875, with a slightly lower partial AUC of 0.833. The analysis using the Zhou-Dendukuri approach revealed low heterogeneity (I2 = 15.9 %). Subgroup analyses showed no significant differences in SROC curves and summary estimates between the ED and ICU settings, although the ED subgroup exhibited higher heterogeneity (I2 = 52.7 % vs. 20.2 %). The comparison between the diagnostic criteria, Sepsis 1 and Sepsis 3, demonstrated similar summary estimates and SROC curves. The examination of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool revealed a high risk of bias regarding the participants and their applicability. Also, there was an increased risk of bias in all the studies concerning the index test. CONCLUSION Based on our research, presepsin is a promising biomarker for triage and early diagnosis of sepsis.
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Affiliation(s)
| | | | - Silvia Demiri
- Department of Internal Medicine, University Hospital of Patras, Patras, Greece.
| | | | - Evangelos Karanikolas
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, USA.
| | - Maria Lagadinou
- Department of Internal Medicine, University Hospital of Patras, Patras, Greece.
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Ahuja N, Mishra A, Gupta R, Ray S. Biomarkers in sepsis-looking for the Holy Grail or chasing a mirage! World J Crit Care Med 2023; 12:188-203. [PMID: 37745257 PMCID: PMC10515097 DOI: 10.5492/wjccm.v12.i4.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/12/2023] [Accepted: 06/12/2023] [Indexed: 09/05/2023] Open
Abstract
Sepsis is defined as a life-threatening organ dysfunction caused by the dysregulated host response to infection. It is a complex syndrome and is characterized by physiologic, pathologic and biochemical abnormalities in response to an infection. Diagnosis of sepsis is based on history, physical examination and other investigations (including biomarkers) which may help to increase the certainty of diagnosis. Biomarkers have been evaluated in the past for many diseases and have been evaluated for sepsis as well. Biomarkers may find a possible role in diagnosis, prognostication, therapeutic monitoring and anti-microbial stewardship in sepsis. Since the pathophysiology of sepsis is quite complex and is incompletely understood, a single biomarker that may be robust enough to provide all information has not been found as of yet. However, many biomarkers have been studied and some of them have applications at the bedside and guide clinical decision-making. We evaluated the PubMed database to search for sepsis biomarkers for diagnosis, prognosis and possible role in antibiotic escalation and de-escalation. Clinical trials, meta-analyses, systematic reviews and randomized controlled trials were included. Commonly studied biomarkers such as procalcitonin, Soluble urokinase-type plasminogen activator (Supar), presepsin, soluble triggering receptor expressed on myeloid cells 1, interleukin 6, C-reactive protein, etc., have been described for their possible applications as biomarkers in septic patients. The sepsis biomarkers are still an area of active research with newer evidence adding to the knowledge base continuously. For patients presenting with sepsis, early diagnosis and prompt resuscitation and early administration of anti-microbials (preferably within 1 h) and source control are desired goals. Biomarkers may help us in the diagnosis, prognosis and therapeutic monitoring of septic patients. The marker redefining our view on sepsis is yet a mirage that clinicians and researchers continue to chase.
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Affiliation(s)
- Neelmani Ahuja
- Department of Critical Care Medicine, Holy Family Hospital, Delhi 110025, India
| | - Anjali Mishra
- Department of Critical Care Medicine, Holy Family Hospital, Delhi 110025, India
| | - Ruchi Gupta
- Department of Critical Care Medicine, Holy Family Hospital, Delhi 110025, India
| | - Sumit Ray
- Department of Critical Care Medicine, Holy Family Hospital, Delhi 110025, India
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Khashaba MA, Abdelal IF, Abd El Rahman SM, Abdel Rahman MH. Sequential estimation of the national early warning score-2 and SERUM PRESEPSIN might discriminate sepsis patients who were vulnerable to death in surgical ICU. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2125249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Mohamed A. Khashaba
- Department of Anesthesia, Pain & ICU, Faculty of Medicine, Benha University, Benha, Egypt
| | - Inas F. Abdelal
- Department of Anesthesia, Pain & ICU, Faculty of Medicine, Cairo University, Giza, Egypt
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Cavaliere F, Biancofiore G, Bignami E, DE Robertis E, Giannini A, Grasso S, Piastra M, Scolletta S, Taccone FS, Terragni P. A year in review in Minerva Anestesiologica 2020: critical care. Minerva Anestesiol 2021; 87:124-133. [PMID: 33538419 DOI: 10.23736/s0375-9393.20.15495-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Franco Cavaliere
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome Italy -
| | - Gianni Biancofiore
- Department of Transplant Anesthesia and Critical Care, University School of Medicine, Pisa, Italy
| | - Elena Bignami
- Division of Anesthesiology, Critical Care and Pain Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Edoardo DE Robertis
- Section of Anesthesia, Analgesia and Intensive Care, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Alberto Giannini
- Unit of Pediatric Anesthesia and Intensive Care, Children's Hospital - ASST Spedali Civili di Brescia, Brescia, Italy
| | - Salvatore Grasso
- Section of Anesthesiology and Intensive Care, Department of Emergency and Organ Transplantation, Polyclinic Hospital, Aldo Moro University, Bari, Italy
| | - Marco Piastra
- Unit of Pediatric Intensive Care and Trauma Center, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Sabino Scolletta
- Department of Emergency-Urgency and Organ Transplantation, Anesthesia and Intensive Care, University Hospital of Siena, Siena, Italy
| | - Fabio S Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pierpaolo Terragni
- Division of Anesthesia and General Intensive Care, Department of Medical, Surgical and Experimental Sciences, University Hospital of Sassari, University of Sassari, Sassari, Italy
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