Background
Methods
Study design and setting
Study population
Data collection
Definitions
Assays
Outcomes
Statistical analysis
Results
Baseline characteristics
Variables | Non-infectious organ failure (n = 142) | Sepsis (n = 141) | Septic shock (n = 137) | p value |
---|---|---|---|---|
Age, median (IQR) | 66 (51–80) | 76 (67–83) | 77 (62–83) | < 0.001 |
Male, n (%) | 85 (56) | 85 (62) | 74 (57) | 0.519 |
Charlson comorbidity index | 4 (3–5) | 3 (3–5) | 5 (4–6) | 0.182 |
Underlying diseases, n (%) | ||||
Diabetes mellitus | 37 (26) | 54 (38) | 51 (37) | 0.055 |
Hypertension | 60 (42) | 78 (55) | 66 (48) | 0.089 |
Malignancy | 23 (16) | 23 (16) | 19 (14) | 0.818 |
Chronic liver disease | 9 (6) | 8 (6) | 11 (8) | 0.720 |
Chronic kidney disease | 7 (5) | 16 (11) | 11 (8) | 0.141 |
Cardiovascular disease | 10 (7) | 15 (11) | 13 (10) | 0.560 |
Site of infection, n (%) | ||||
Respiratory | 84 (60) | 81 (59) | 0.713 | |
Genitourinary | 35 (25) | 33 (24) | 0.367 | |
Gastrointestinal | 14 (10) | 13 (10) | 0.386 | |
Others | 13 (9) | 15 (11) | 0.281 | |
Positive blood culture, n (%) | 60 (43) | 62 (45) | 0.412 | |
APACHE II score, median (IQR) | 23 (18–29) | 26 (22–32) | 29 (25–33) | < 0.001 |
SOFA score, median (IQR) | 6 (3–8) | 6 (5–8) | 10 (8–12) | < 0.001 |
NEWS, median (IQR) | 9 (7–11) | 10 (8–12) | 11 (9–14) | < 0.001 |
MEWS, median (IQR) | 5 (4–7) | 6 (5–7) | 7 (6–9) | < 0.001 |
WBC (× 109/L), median (IQR) | 11.30 (8.17–14.63) | 11.94 (8.24–17.06) | 11.22 (6.68–20.04) | 0.343 |
CRP (mg/dL), median (IQR) | 0.53 (0.13–2.42) | 7.50 (3.33–16.66) | 10.07 (3.99–20.70) | < 0.001 |
Procalcitonin (ng/mL), median (IQR) | 0.10 (0.05–0.25) | 0.98 (0.35–4.25) | 4.22 (0.88–21.02) | < 0.001 |
Presepsin (pg/mL), median (IQR) | 286 (170–417) | 792 (450–1273) | 1287 (589–2366) | < 0.001 |
Lactate (mmol/L), median (IQR) | 2.0 (1.4–4.6) | 2.2 (1.5–4.9) | 4.4 (2.4–8.1) | < 0.001 |
Creatinine (mg/dL), median (IQR) | 1.3 (0.9–2.1) | 1.3 (0.9–2.5) | 1.7 (1.1–2.6) | < 0.001 |
Bilirubin (mg/dL), median (IQR) | 0.6 (0.4–1.1) | 0.7 (0.4–1.3) | 0.7 (0.4–1.2) | 0.003 |
Platelet (× 1000/μL), median (IQR) | 200 (139–286) | 206 (142–301) | 185 (102–258) | 0.002 |
Length of hospital stay (days), median (IQR) | 8 (3–15) | 8 (3–14) | 11 (4–17) | 0.243 |
Length of ICU stay (days), median (IQR) | 4 (2–5) | 4 (2–6) | 5 (2–7) | 0.218 |
7-day mortality | 11 (7.2) | 11 (8.0) | 33 (25.2) | < 0.001 |
14-day mortality | 16 (10.5) | 19 (13.9) | 40 (30.5) | < 0.001 |
30-day mortality | 20 (13.2) | 22 (16.1) | 47 (35.9) | < 0.001 |
90-day mortality | 21 (13.8) | 33 (24.1) | 52 (39.7) | < 0.001 |
Organs | Main clinical diagnoses | n (%) |
---|---|---|
Central nervous system (n = 52) | Cerebral hemorrhage (ICH, IVH, SAH, and SDH) | 12 (8.5) |
Cerebral infarction | 5 (3.5) | |
Seizure | 11 (7.7) | |
Hypoglycemia | 4 (2.8) | |
Metabolic encephalopathy | 13 (9.2) | |
Heat stroke | 2 (1.4) | |
Others | 5 (3.5) | |
Cardiovascular (n = 41) | Heart failure | 12 (8.5) |
Pulmonary embolism | 5 (3.5) | |
Hypovolemic (hemorrhagic) shock | 17 (12.0) | |
Aortic dissection | 4 (2.8) | |
Others | 3 (2.1) | |
Respiratory (n = 21) | COPD or asthma | 12 (8.5) |
Malignancy in respiratory system | 4 (2.8) | |
Airway obstruction | 3 (2.1) | |
Others | 2 (1.4) | |
Hepatobiliary (n = 19) | Liver cirrhosis aggravation | 11 (7.7) |
Hepatobiliary malignancy | 5 (3.5) | |
Others | 3 (2.1) | |
Renal (n = 14) | Acute kidney injury | 9 (6.3) |
Under dialysis in pre-existing CKD | 5 (3.5) | |
Coagulation (n = 7) | Hematologic malignancy | 4 (2.8) |
Thrombocytopenia | 3 (2.1) |
Presepsin, PCT, and CRP measurement
Correlations with other biomarkers and severity scores
Diagnostic value of presepsin, PCT, and CRP
Tested biomarker | AUC (95% CI) | p value | Cut-off value | Sensitivity, (%) | Specificity, (%) |
---|---|---|---|---|---|
Presepsin | |||||
Sepsis vs. non-infectious organ failure | 0.877 (0.841–0.906) | < 0.001 | 582 (pg/mL) | 70.1 | 89.4 |
Septic shock vs. sepsis | 0.618 (0.558–0.675) | < 0.001 | 1285 (pg/mL) | 50.4 | 76.6 |
Procalcitonin | |||||
Sepsis vs. non-infectious organ failure | 0.908 (0.877–0.934) | < 0.001 | 0.51 (ng/mL) | 75.5 | 93.0 |
Septic shock vs. sepsis | 0.678 (0.619–0.732) | < 0.001 | 2.81 (ng/mL) | 59.1 | 70.9 |
CRP | |||||
Sepsis vs. non-infectious organ failure | 0.858 (0.821–0.890) | < 0.001 | 3.53 (mg/L) | 77.0 | 85.2 |
Septic shock vs. sepsis | 0.559 (0.498–0.618) | 0.088 | 6.62 (mg/L) | 65.7 | 46.8 |
Prognostic value of presepsin
Variables | All septic patients (n = 278) | Survivors (n = 204) | Non-survivors (n = 74) | p value |
---|---|---|---|---|
Age, median (IQR) | 77 (64–84) | 77 (64–83) | 78 (65–85) | 0.210 |
Male, n (%) | 162 (58) | 120 (59) | 42 (57) | 0.757 |
Charlson comorbidity index | 4 (3–5) | 3 (3–5) | 5 (4–6) | 0.157 |
Site of infection, n (%) | ||||
Respiratory | 165 (59) | 119 (58) | 46 (62) | 0.658 |
Genitourinary | 68 (24) | 48 (24) | 20 (27) | 0.412 |
Gastrointestinal | 27 (10) | 20 (10) | 7 (9) | 0.348 |
Others | 28 (10) | 21 (10) | 7 (9) | 0.316 |
Septic shock, n (%) | 85 (42) | 52 (70) | < 0.001 | |
APACHE II score, median (IQR) | 28 (24–33) | 27 (22–31) | 31 (26–37) | < 0.001 |
SOFA score, median (IQR) | 9 (6–11) | 8 (6–10) | 11 (9–12) | < 0.001 |
NEWS, median (IQR) | 11 (9–13) | 10 (9–12) | 12 (10–14) | 0.002 |
MEWS, median (IQR) | 6 (5–7) | 6 (5–7) | 6 (5–9) | 0.043 |
WBC (× 109/L), median (IQR) | 11.68 (7.65–18.07) | 11.91 (8.38–19.66) | 10.76 (5.06–15.75) | 0.009 |
CRP (mg/L), median (IQR) | 9.09 (3.87–17.34) | 8.69 (3.57–17.07) | 10.75 (4.80–19.04) | 0.270 |
Procalcitonin (ng/mL), median (IQR) | 1.74 (0.51–8.51) | 1.61 (0.47–8.95) | 2.06 (0.62–7.22) | 0.666 |
Presepsin (pg/mL), median (IQR) | 934 (512–1802) | 815 (460–1678) | 1142 (650–2039) | < 0.001 |
Creatinine (mg/dL), median (IQR) | 1.5 (1.0–2.5) | 1.4 (0.9–2.6) | 1.7 (1.0–2.2) | 0.627 |
Bilirubin (mg/dL), median (IQR) | 0.7 (0.4–1.2) | 0.6 (0.4–1.0) | 1.0 (0.5–1.7) | < 0.001 |
Platelet (× 1000/μL), median (IQR) | 197 (115–288) | 206 (141–305) | 145 (63–212) | < 0.001 |
Lactate (mmol/L), median (IQR) | 3.1 (1.9–6.6) | 2.6 (1.6–5.2) | 6.0 (2.9–9.9) | < 0.001 |
Univariate HR (95% CI) | p value | Multivariate HR (95% CI) | p value | |
---|---|---|---|---|
SOFA score | 1.247 (1.167–1.332) | < 0.001 | 1.264 (1.167–1.369) | < 0.001 |
APACHE II score | 1.223 (1.183–1.265) | < 0.001 | 1.131 (0.982–1.417) | 0.127 |
Septic shock | 2.752 (1.671–4.531) | < 0.001 | 1.621 (0.919–2.861) | 0.095 |
Lactate | 1.113 (1.078–1.149) | < 0.001 | 1.108 (1.070–1.147) | < 0.001 |
Presepsin | 1.013 (1.003–1.025) | 0.018 | 1.003 (1.001–1.005) | 0.042 |
Bilirubin | 1.050 (0.990–1.115) | 0.105 | 1.014 (0.927–1.109) | 0.755 |
Platelet | 0.995 (0.993–0.998) | < 0.001 | 0.998 (0.996–1.001) | 0.216 |
WBC | 0.973 (0.945–0.997) | 0.013 | 0.989 (0.971–1.008) | 0.083 |