Diagnostic and prognostic value of soluble CD14 subtype (Presepsin) for sepsis and community-acquired pneumonia in ICU patients

Klouche et al. Ann. Intensive Care (2016) 6:59 DOI 10.1186/s13613-016-0160-6 Open Access RESEARCH Diagnostic and prognostic value of soluble CD14 subtype (Presepsin) for sepsis and community‑acquired pneumonia in ICU patients Kada Klouche1,2* , Jean Paul Cristol2,3, Julie Devin3, Vincent Gilles1, Nils Kuster3, Romaric Larcher1, Laurent Amigues1, Philippe Corne1, Olivier Jonquet1 and Anne Marie Dupuy3 Abstract Background: The soluble CD14 subtype, Presepsin, appears to be an accurate sepsis diagnostic marker, but data from intensive care units (ICUs) are scarce. This study was conducted to evaluate the diagnostic and prognostic value of Presepsin in ICU patients with severe sepsis (SS), septic shock (SSh) and severe community-acquired pneumonia (sCAP). Methods: Presepsin and procalcitonin (PCT) levels were determined for patients at admission to ICU. Four groups have been differentiated: (1) absence or (2) presence of systemic inflammatory response syndrome, (3) SS or (4) SSh; and 2 groups, among the patients admitted for acute respiratory failure: absence or presence of sCAP. Biomarkers were tested for diagnosis of SS, SSh and sCAP and for prediction of ICU mortality. Results: One hundred and forty-four patients were included: 44 SS and 56 SSh. Plasma levels of Presepsin and PCT were significantly higher in septic than in non-septic patients and in SSh as compared to others. The sepsis diagnostic accuracy of Presepsin was not superior to that of PCT (AUC: 0.75 vs 0.80). In the 72/144 patients admitted for acute respiratory failure, the capability of Presepsin to diagnose sCAP was significantly better than PCT. Presepsin levels were also predictive of ICU mortality in sepsis and in sCAP patients. Conclusion: Plasma levels of Presepsin were useful for the diagnosis of SS, SSh and sCAP and may predict ICU mortality in these patients. Keywords: Severe sepsis, Septic shock, Diagnosis, Prognosis, Presepsin, Procalcitonin, Community-acquired pneumonia Background Despite advances in therapy, sepsis is the leading cause of death in critical care settings [1]. To improve the survival, early recognition of severe sepsis and septic shock and subsequent introduction of an aggressive supportive therapy are mandatory [2]. In routine clinical practice, early anti-infection treatment should be given *Correspondence: k‑klouche@chu‑montpellier.fr 1 Intensive Care Medicine Department, Lapeyronie University Hospital, 371, Av Doyen G. Giraud, 34295 Montpellier, France Full list of author information is available at the end of the article before definitive diagnosis since blood culture, the goldstandard diagnostic method, usually takes several days to obtain the results and frequently yields low positive results. In fact, adequate microbiological information, ensuring appropriate therapy and avoiding unnecessary or unduly prolonged therapy, is lacking in more than 50 % of clinical situations. In this purpose, novel biomarkers have been developed and are being widely adopted in clinical settings. Among these biomarkers, procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP) are the main diagnostic markers used for bacterial sepsis. PCT is known to have the highest specificity, but its © 2016 The Author(s). This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Klouche et al. Ann. Intensive Care (2016) 6:59 levels may increase in conditions without bacterial infection, such as severe trauma, invasive surgical procedure and critical burn injuries, thus resulting in false-positive results [3–5]. More recently, the soluble CD14 subtype, Presepsin, appears to be an accurate sepsis diagnostic marker and rises up a great clinical interest. Levels of Presepsin were found significantly higher in septic than in non-septic patients or those with SIRS [6]. Moreover, a specific increase was reported in the early stage of sepsis that also well correlated with severity [7]. Accordingly, plasma Presepsin levels could be useful for diagnosis and prognosis of sepsis and also for monitoring the course of the disease [8, 9]. Most of these studies have been, however, performed in settings of emergency departments [10– 13], and data from intensive care units (ICUs) are scarce. Also, few studies have focused on community-acquired pneumonia [14–16]. In addition, plasma concentrations of Presepsin in most of previous reports were determined by ELISA method, which is time-consuming and not suitable for emergency. Yet, the new development of a fully automated point of care assay for rapid whole-blood Presepsin measurement updated its clinical use in emergency and ICUs [8, 11, 17]. Therefore, this study aimed to evaluate the diagnostic and prognostic utility of Presepsin measurements using the new fast method in severe sepsis and septic shock intensive care unit (ICU) patients. We also aimed to evaluate the diagnostic and prognostic utility of Presepsin measurements for severe community-acquired pneumonia (sCAP) in the subgroup of patients admitted to the ICU with acute respiratory failure. Methods This observational prospective study was performed at 2 ICUs of Lapeyronie and Gui de Chauliac University hospitals of Montpellier, France. These two ICUs admit preferentially patients with suspected infectious diseases. It was carried out according to the principles of the Declaration of Helsinki and was approved by the Ethic Committee of Montpellier (Comité de protection des Personnes: CPP du CHU de Montpellier). Written informed consent was obtained from all participating patients or their closest relatives or legal representatives. Study population All consecutive patients admitted to ICUs from January to May 2014 were included. Exclusion criteria were pregnancy, age < 18 years, previous congestive heart failure (class NYHA ≥ III), right ventricular failure, chronic renal failure stage III KDOQI or more, hepatic failure and acute pulmonary embolism. Page 2 of 11 Methods Baseline clinical variables including age, gender, cause of sepsis, and comorbidities were collected. The severity of disease was assessed by SAPS II [18] and SOFA scores [19]. At ICU admission, clinical and biological parameters including mean arterial pressure (MAP), serum creatinine, hsCRP, and PCT were also collected. ICU length of stay was recorded; ICU and in-hospital mortality were assessed. Diagnosis of systemic inflammatory response syndrome (SIRS) and of sepsis severity was based on established criteria of the American College of Chest Physicians/Society of Critical Care Medicine [20]. Microbiological cultures were carried out. Patients who revealed a microbiologically or clinically pro (...truncated)