Prognostic Value of Plasma Presepsin and Pneumonia Severity Index in Patients with Community-Acquired Pneumonia in the Emergency Department
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Variables
2.3. Statistics
3. Results
3.1. Demographics and Clinical Information
3.2. Association of PSS Levels and Disease Severity
3.3. Association of PSS Levels and Clinical Outcomes
3.4. Predictive Mortality Value of PSS Levels
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Thomas, C.P.; Ryan, M.; Chapman, J.D.; Stason, W.B.; Tompkins, C.P.; Suaya, J.; Polsky, D.; Mannino, D.M.; Spepard, D.S. Incidence and cost of pneumonia in medicare beneficiaries. Chest 2012, 142, 973–981. [Google Scholar] [CrossRef] [PubMed]
- Huang, Y.; Deng, W.; Zheng, S.; Feng, F.; Huang, Z.; Huang, Q.; Guo, X.; Huang, Z.; Huang, X.; Pan, X.; et al. Relationship between monocytes to lymphocytes ratio and axial spondyloarthritis. Int. Immunopharmacol. 2018, 57, 43–46. [Google Scholar] [CrossRef] [PubMed]
- Pantzaris, N.D.; Platanaki, C.; Pierrako, C.; Karamouzos, V.; Velissaris, D. Neutrophil-to-lymphocyte ratio relation to sepsis severity scores and inflammatory biomarkers in patients with community-acquired pneumonia: A case series. J. Transl. Int. Med. 2018, 6, 43–46. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Chalmers, J.D.; Singanayagam, A.; Hill, A.T. C-reactive protein is an independent predictor of severity in community-acquired pneumonia. Am. J. Med. 2008, 121, 219–225. [Google Scholar] [CrossRef]
- Andrijevic, I.; Matijasevic, J.; Andrijevic, L.; Kovacevic, T.; Zaric, B. Interleukin-6 and procalcitonin as biomarkers in mortality prediction of hospitalized patients with community acquired pneumonia. Ann. Thorac. Med. 2014, 9, 162–167. [Google Scholar]
- Wang, Y.; Zhang, S.; Li, L.; Xie, J. The usefulness of serum procalcitonin, C-reactive protein, soluble triggering receptor expressed on myeloid cells 1 and Clinical Pulmonary Infection Score for evaluation of severity and prognosis of community-acquired pneumonia in elderly patients. Arch. Gerontol. Geriatr. 2019, 80, 53–57. [Google Scholar] [CrossRef]
- Yaegashi, Y.; Shirakawa, K.; Sato, N.; Suzuki, Y.; Kojika, M.; Imai, S.; Takahashi, G.; Miyata, M.; Furusako, S.; Endo, S. Evaluation of a newly identified soluble CD14 subtype as a marker for sepsis. J. Infect. Chemother. 2005, 11, 234–238. [Google Scholar] [CrossRef]
- Ali, F.T.; Ali, M.A.; Elnakeeb, M.M.; Bendary, H.N. Presepsin is an early monitoring biomarker for predicting clinical outcome in patients with sepsis. Clin. Chim. Acta. 2016, 460, 93–101. [Google Scholar] [CrossRef]
- Shozushima, T.; Takahashi, G.; Matsumoto, N.; Kojika, M.; Okamura, Y.; Endo, S. Usefulness of presepsin (sCD14-ST) measurements as a marker for the diagnosis and severity of sepsis that satisfied diagnostic criteria of systemic inflammatory response syndrome. J. Infect. Chemother. 2011, 17, 764–769. [Google Scholar] [CrossRef]
- Liu, B.; Yin, Q.; Chen, Y.X.; Zhao, Y.Z.; Li, C.S. Role of Presepsin (sCD14-ST) and the CURB65 scoring system in predicting severity and outcome of community-acquired pneumonia in an emergency department. Respir. Med. 2014, 108, 1204–1213. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ugajin, M.; Matsuura, Y.; Matsuura, K.; Matsuura, H. Impact of initial plasma presepsin level for clinical outcome in hospitalized patients with pneumonia. J. Thorac. Dis. 2019, 11, 1387–1396. [Google Scholar] [CrossRef] [PubMed]
- Mandell, L.A.; Wunderink, R.G.; Anzueto, A.; Bartlett, J.G.; Campbell, G.D.; Dean, N.C.; Dowell, S.F.; File, T.M.; Musher, D.M.; Niederman, M.S. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin. Infect. Dis. 2007, 44 (Suppl. 2), S27–S72. [Google Scholar] [CrossRef] [PubMed]
- Masson, S.; Caironi, P.; Spanuth, E.; Thomae, R.; Panigada, M.; Sangiorgi, G.; Fumagalli, R.; Mauri, T.; Isgrò, S.; Fanizza, C. Presepsin (soluble CD14 subtype) and procalcitonin levels for mortality prediction in sepsis: Data from the Albumin Italian Outcome Sepsis trial. Crit. Care 2014, 18, R6. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Becker, K.L.; Snider, R.; Nylen, E.S. Procalcitonin assay in systemic inflammation, infection, and sepsis: Clinical utility and limitations. Crit. Care Med. 2008, 36, 941–952. [Google Scholar] [CrossRef] [PubMed]
- Okamura, Y.; Yokoi, H. Development of a point-of-care assay system for measurement of presepsin (sCD14-ST). Clin. Chim. Acta. 2011, 412, 2157–2161. [Google Scholar] [CrossRef] [PubMed]
- Chenevier-Gobeaux, C.; Borderie, D.; Weiss, N.; Mallet-Coste, T.; Claessens, Y.E. Presepsin (sCD14-ST), an innate immune response marker in sepsis. Clin. Chim. Acta. 2015, 450, 97–103. [Google Scholar] [CrossRef]
- Wen, M.Y.; Huang, L.Q.; Yang, F.; Ye, J.K.; Cai, G.X.; Li, X.S.; Ding, H.G.; Zeng, H.K. Presepsin level in predicting patients’ in-hospital mortality from sepsis under sepsis-3 criteria. Ther. Clin. Risk Manag. 2019, 15, 733–739. [Google Scholar] [CrossRef] [Green Version]
- Qi, Z.J.; Yu, H.; Zhang, J.; Li, C.S. Presepsin as a novel diagnostic biomarker for differentiating active pulmonary tuberculosis from bacterial community acquired pneumonia. Clin. Chim. Acta. 2018, 478, 152–156. [Google Scholar] [CrossRef]
- Halıcı, A.; Hür, İ.; Abatay, K.; Çetin, E.; Halıcı, F.; Özkan, S. The role of presepsin in the diagnosis of chronic obstructive pulmonary disease acute exacerbation with pneumonia. Biomark. Med. 2020, 14, 31–41. [Google Scholar] [CrossRef]
- Savić, D.; Simović, A.; Marković, S.; Kostić, G.; Vuletić, B.; Radivojević, S.; Lišanin, M.; Igrutinović, Z.; Pavlović, R. The role of presepsin obtained from tracheal aspirates in the diagnosis of early onset pneumonia in intubated newborns. Indian J. Pediatr. 2018, 85, 968–973. [Google Scholar] [CrossRef]
- Ham, J.Y.; Song, K.E. A prospective study of presepsin as an indicator of the severity of community-acquired pneumonia in emergency departments: Comparison with pneumonia severity index and CURB-65 scores. Lab. Med. 2019, 50, 364–369. [Google Scholar] [CrossRef] [PubMed]
- Klouche, K.; Cristol, J.P.; Devin, J.; Gilles, V.; Kuster, N.; Larcher, R.; Amigues, L.; Corne, P.; Jonquet, O.; Dupuy, A.M. Diagnostic and prognostic value of soluble CD14 subtype (Presepsin) for sepsis and community-acquired pneumonia in ICU patients. Ann. Intensive Care 2016, 6, 59. [Google Scholar] [CrossRef] [PubMed]
Variable | All (n = 211) | Outcome | p-Value | |
---|---|---|---|---|
Survivors (n = 167) | Non-Survivors (n = 44) | |||
Age, y | 78 (66–84) | 77 (64–84) | 80 (73–85) | 0.067 |
Male, n (%) | 123 (58.3%) | 98 (58.7%) | 25 (56.8%) | 0.477 |
Comorbidities, n (%) | ||||
Diabetes mellitus | 65 (30.8%) | 51 (30.5%) | 14 (31.8%) | 0.502 |
Hypertension | 96 (45.5%) | 79 (47.3%) | 17 (38.6%) | 0.196 |
Cerebrovascular disease | 77 (36.5%) | 60 (35.9%) | 17 (38.6%) | 0.435 |
Chronic liver disease | 10 (4.7%) | 6 (3.6%) | 4 (9.1%) | 0.131 |
Chronic lung disease | 14 (6.6%) | 10 (6.0%) | 4 (9.1%) | 0.329 |
Congestive heart disease | 8 (3.8%) | 7 (2.4%) | 1 (2.3%) | 0.475 |
Clinical presentation | ||||
Systolic blood pressure | 125 (105–142) | 127 (107–143) | 116 (88–144) | 0.067 |
Diastolic blood pressure | 70 (59–80) | 71 (62–81) | 66 (53–78) | 0.020 |
Pulse rate | 103 ± 21 | 102 ± 21 | 106 ± 22 | 0.275 |
Respiratory rate | 20 (19–24) | 20 (20–23) | 23 (20–30) | 0.012 |
Body temperature | 37.5 ± 1.1 | 37.6 ± 1.1 | 37.1 ± 1.1 | 0.027 |
CURB-65 score | 2 (1–3) | 2 (1–3) | 3 (2–4) | <0.001 |
Pneumonia severity index | 109 ± 37 | 100 ± 33 | 141 ± 33 | <0.001 |
Bacteremia, n (%) | 47 (22.3%) | 35 (21.0%) | 12 (27.3%) | 0.241 |
ICU admission, n (%) | 69 (32.7%) | 40 (24.0%) | 29 (65.9%) | <0.001 |
Variable | Low Risk (PSI < 91) | Moderate Risk (PSI 91–130) | High Risk (PSI > 130) |
---|---|---|---|
Number, n | 71 | 79 | 61 |
Mortality, n (%) | 4 (5.6%) b,c | 9 (11.4%) a,c | 31 (50.8%) a,b |
WBC count, ×103/μL | 11.8 ± 4.8 | 11.3 ± 5.0 | 12.2 ± 6.7 |
hsCRP level, mg/dL | 8.37 (2.74–14.93) | 9.41 (4.94–21.08) | 10.14 (4.50–19.80) |
Lactate level, mmol/L | 1.81 (1.21–2.48) b,c | 2.23 (1.56–3.24) a,c | 3.07 (2.09–5.16) a,b |
Procalcitonin level, ng/mL | 0.14 (0.05–0.30) b,c | 0.26 (0.10–1.03) a,c | 0.78 (0.30–5.58) a,b |
Presepsin level, pg/mL | 295 (214–488) b,c | 422 (298–583) a,c | 720 (525–1318) a,b |
Variable | Survivors (n = 167) | Non-Survivors (n = 44) | p-Value |
---|---|---|---|
WBC count, ×103/μL | 11.6 ± 5.0 | 12.3 ± 7.0 | 0.471 |
hsCRP level, mg/dL | 8.36 (3.30–17.68) | 12.45 (4.89–20.68) | 0.063 |
Lactate level, mmol/L | 2.22 (1.51–3.13) | 2.77 (1.89–4.23) | 0.020 |
Procalcitonin level, ng/mL | 0.22 (0.06–0.79) | 0.70 (0.27–12.76) | <0.001 |
Presepsin level, pg/mL | 385 (245–554) | 1083 (697–1736) | <0.001 |
Variable | AUC (95% CI) | Cutoff Value | Sensitivity (%) | Specificity (%) | Youden’s Index | p-Value |
---|---|---|---|---|---|---|
CURB-65 score | 0.717 (0.652–0.777) | >2 | 61.4 | 73.7 | 0.350 | <0.001 |
PSI | 0.813 (0.754–0.863) | >126 | 72.7 | 82.0 | 0.548 | <0.001 |
WBC count | 0.511 (0.442–0.581) | >6.3 × 103/μL | 75.0 | 15.0 | 0.100 | 0.831 |
hsCRP | 0.591 (0.522–0.658) | >8.63 mg/dL | 71.7 | 53.3 | 0.260 | 0.050 |
Lactate | 0.616 (0.544–0.683) | >2.81 mmol/L | 48.8 | 72.2 | 0.210 | 0.020 |
Procalcitonin | 0.728 (0.661–0.789) | >0.22 ng/mL | 83.3 | 52.8 | 0.362 | <0.001 |
Presepsin | 0.867 (0.814–0.910) | >754 pg/mL | 72.7 | 91.6 | 0.643 | <0.001 |
Variable | Univariate Analysis | Multivariate Analysis | ||
---|---|---|---|---|
HR (95% CI) | p-Value | HR (95% CI) | p-Value | |
Age | 1.029 (1.004–1.054) | 0.021 | ||
Sex | 1.071 (0.590–1.944) | 0.822 | ||
Comorbidity | 1.596 (0.712–3.581) | 0.257 | ||
CURB-65 score > 2 | 4.580 (2.277–9.214) | <0.001 | ||
PSI > 126 | 12.178 (5.626–26.358) | <0.001 | 6.375 (2.374–17.122) | <0.001 |
Bacteremia | 1.429 (0.736–2.774) | 0.306 | ||
ICU admission | 4.909 (2.628–9167) | <0.001 | ||
WBC count > 6.3 × 103/μL | 0.544 (0.275–1.077) | 0.081 | ||
hsCRP level > 8.63 mg/dL | 2.700 (1.390–5.242) | 0.003 | ||
Lactate level > 2.81 mmol/L | 2.363 (1.299–4.300) | 0.005 | ||
Procalcitonin level > 0.22 ng/mL | 4.798 (2.130–10.808) | <0.001 | ||
Presepsin level > 754 pg/mL | 15.336 (7.842–29.991) | <0.001 | 19.472 (7.262–52.209) | <0.001 |
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Lee, K.-R.; Hong, D.-Y.; Paik, J.-H.; Jung, H.-M. Prognostic Value of Plasma Presepsin and Pneumonia Severity Index in Patients with Community-Acquired Pneumonia in the Emergency Department. Medicina 2022, 58, 1504. https://doi.org/10.3390/medicina58111504
Lee K-R, Hong D-Y, Paik J-H, Jung H-M. Prognostic Value of Plasma Presepsin and Pneumonia Severity Index in Patients with Community-Acquired Pneumonia in the Emergency Department. Medicina. 2022; 58(11):1504. https://doi.org/10.3390/medicina58111504
Chicago/Turabian StyleLee, Kyeong-Ryong, Dae-Young Hong, Jin-Hui Paik, and Hyun-Min Jung. 2022. "Prognostic Value of Plasma Presepsin and Pneumonia Severity Index in Patients with Community-Acquired Pneumonia in the Emergency Department" Medicina 58, no. 11: 1504. https://doi.org/10.3390/medicina58111504