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2018, vol. 75, br. 10, str. 968-977
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Prognostička vrednost presepsina (solubilnog CD 14-podtipa) u dijagnozi pneumonija povezanih sa mehaničkom ventilacijom i sepse kod traumatizovanih bolesnika
Prognostic value of presepsin (soluble CD14-subtype) in diagnosis of ventilator-associated pneumonia and sepsis in trauma patients
aUniverzitet u Beogradu, Medicinski fakultet + Klinički centar Srbije, Centar za anesteziologiju i reanimatologiju, Beograd bUniverzitet u Beogradu, Medicinski fakultet + Univerzitet u Beogradu, Medicinski fakultet, Institut za epidemiologiju cUniverzitet u Beogradu, Medicinski fakultet + Klinički centar Srbije, Centar za medicinsku biohemiju, Beograd dUniverzitet u Beogradu, Medicinski fakultet + Klinički centar Srbije, Urgentni centar, Klinika za urgentnu hirurgiju , Beograd eKlinički centar Srbije, Centar za medicinsku biohemiju, Beograd fUniverzitet u Beogradu, Medicinski fakultet, Institut za farmakologiju, kliničku farmakologiju i toksikologiju
e-adresa: bjovanovic@outlook.com
Projekat: Kliničko epidemiološka istraživanja najčešćih neželjenih događaja tokom bolničkog lečenja (MPNTR - 175046)
Sažetak
Uvod/Cilj. Persepsin (solubilni CD14-podtip) je fragment CD14 koji se produkuje kao odgovor na prisustvo bakterijske infekcije i predstavlja novi biomarker u dijagnostici pneumonije, sepse i spetičkog šoka. Cilj ove studije bio je da se uporedi senzitivnost i specifičnost presepsina (solubilnog CD14-podtipa) sa ostalim biomarkerima infekcije: prokalcitoninom (PCT), C-reaktivnim proteinom (CRP) i brojem leukocita (Le) kod povređenih bolesnika na mehaničkoj ventilaciji, kao markera pneumonije, sepse i septičkog šoka. Metode. Prospektivna studija sprovedena je u dve jedinice intenzivnog lečenja (JIL) (traumatološka i hirurška) Kliničkog centra Srbije u periodu od januara do aprila 2013. godine. U studiju je bilo uključeno 39 traumatizovanih bolesnika na mehaničkoj ventilaciji kod kojih se razvio neki od sledećih ishoda koji su bili i kriterijumi za uključivanje: sisemski inflamatorni odgovor (SIRS), pneumonija povezana sa mehaničkom ventilacijom (VAP), sepsa i/ili septički šok. Na prijemu u JIL Acute Physiology and Chronic Health Evaluation II (APACHE II) skor i Injury Severity Score (ISS) su računati za svakog bolesnika. Sedamdeset i dva merenja koncentracije četiri biomarkera (presepsin, PCT, CRP i Le) urađena su kod 39 bolesnika u trenutku postavljanja dijagnoze SIRS, VAP, sepse i/ili septičkog šoka. Sequential Organ Failure Assessment (SOFA) skor takođe je meren istovremeno. Rezultati. Većina bolesnika na prijemu bila je teško povređena (srednja vrednost ISS skora = 24.2) i bila je u srednje teškom stanju (srednja vrednost APACHE II skora = 14.5). Koncentracije presepsina značajno su se razlikovale između sve četiri grupe bolesnika, osim između grupa sa sepsom i septičkim šokom. Najsnažniju pozitivnu korelaciju presepsin je imao sa PCT (r = 0.741, p < 0.001). sCD14-ST pokazao je bolju prediktivnu vrednost u dijagnozi pneumonije (AUC = 0.909) i sepse (AUC = 0.899) u odnosu na PCT (AUCs: 0.863, 0.855), CRP (AUCs: 0.703, 0.677) i Le (AUCs: 0.688, 0.700). Zaključak. Ova studija je pokazala da je sCD14-ST pouzdan biomarker u određivanju težine sepse kao i da je u dobroj korelaciji sa nastankom infekcije i pogoršanjem stanja kod povređenih bolesnika.
Abstract
Background/Aim. Presepsin (soluble CD14-subtype) is a fragment of CD14 produced in response to bacterial infections and a novel biomarker of pneumonia, sepsis and septic shock. The aim of this study was to compare sensitivity and specificity of persepsin, soluble CD14-subtype (sCD14-ST) with other biomarkers: procalcitonine (PCT), C-reactive protein (CRP) and leukocyte count (Le) in mechanically ventilated injured patients, as a marker of pneumonia, sepsis and septic shock. Methods. The prospective study was undertaken in trauma and surgery intensive care unit of the Emergency Center, the Clinical Center of Serbia from January to April 2013. The study included 39 trauma patients requiring mechanical ventilation, and who developed one of the following inclusion criteria: Systemic Inflammatory Response Syndrome (SIRS), ventilator associated pneumonia (VAP), sepsis and/or septic shock. On admission Acute Physiology and Chronic Health Evaluation II (APACHE II) Score and Injury Severity Score (ISS) were calculated. Seventy-two measurements of four biomarkers (presepsin, PCT, CRP and Le) were performed in 39 patients at the moments of diagnosis of SIRS, VAP, sepsis and/or septic shock (21 when SIRS diagnosis was established, 21 after the diagnosis of VAP, 18 at the moment of diagnosis of sepsis and the remaining 12 measurements were conducted while diagnosing the septic shock). The Sequential Organ Failure Assessment (SOFA) score was calculated at these points as well. Results. Patients were mainly severely injured (mean ISS = 24.2) and had moderately severe medical condition at admission (mean Apache II score, 14.5). Presepsin concentration significantly differed among all the four groups, except between sepsis and septic shock. The strongest positive correlation of presepsin evinced with PCT (r = 0.741, p < 0.001). The sCD14-ST indicated better performance in diagnosis of both VAP (AUC = 0.909) and sepsis (AUC = 0.899), compared to PCT (AUCs: 0.863, 0.885, respectively), CRP (AUCs: 0.703, 0.677, respectively) and Le (AUCs: 0.668, 0.700, respectively). Conclusion. This study revealed that sCD14-ST is a reliable biomarker for distinguishing sepsis severity. It also showed a good correlation with the infection development as well as worsening in injured patients.
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