The Investigation of soluble urokinase plasminogen activator receptor (suPAR) as an early marker of prognosis and mortality in children with sepsis and septic shock: 1-year prospective study
Project no. 20230 · Status: Kapanmış (Yayın bekleniyor) · 2019
Summary
The sepsis and septic shock remain major causes of child morbidity and mortality, despite the use of modern antibiotics and resuscitation therapies. Recent interest has focused on biomarkers for early diagnosis, and evaluation the outcomes of sepsis; but there is a still lack of early diagnosis and timely intervention for sepsis in the emergency department (ED). The primary aim was to investigate the role of C-Reactive Protein(CRP), Procalcitonin(PCT), soluble-urokinase plasminogen activator receptor(suPAR) and Presepsin in the early stratification of patients with sepsis. The usefulness of pediatric Sequential Organ Failure Assessment (pSOFA) for predicting of the mortality and the rate of PICU admission in children with septik shock were also investigated. This prospective pilot study was conducted at academic pediatric ED between September 2017-June 2018. All children who met sepsis criteria admitted to ED were involved to study. They kept following up after ED management and their blood samples were taken upon admission on day 0, 1, 2, 4 and 7. The definition made as sepsis, severe sepsis and septic shock. At the same period, 100 healthy children chosen as the control group. The patient characteristics, clinical features, diagnosis, co-morbidities, source of infection, laboratory results (CRP, PCT, lactate, suPAR and Presepsin) and treatments were recorded. The pSOFA score was calculated during first hour of admission. Length of stay in ED and hospital was noted. The main outcome measure was in 7 and 30-day mortality. Seventy-two children with sepsis (n=15), severe sepsis (n=21) or septic shock (n=36) were admitted to the pediatric ED. The median age was 12.1 months (IQR 1-11.5; min 1 mo-max 10 yrs); F/M ratio was 36/36. The source-of-infection was pneumonia in 24 (34%), bacteriemia in 20, gastrointestinal in 12, catheter infections in 7, meningitis in 4 and meningococcemia in 2. Overall mortality rate was 15.3% (11/72) and three patient died in the first 24 hour of admission. Two of remaining 69 children died in D1-D2, both two in D2-D4 and D4-D7 and 2 children died in D7-D28. All mortalities were seen in children who had underlying disease (p<0.05). The suPAR values were significantly higher in patients groups than control at the admission to the ED (p<0.001). Although, there was no significant difference between median PCT and CRP values with mortality, plasma suPAR and presepsin values were more higher in non-survivors (p<0.001). The sensitivity, specificity, NPV and PPV of suPAR >0.69 ng/mL and presepsin >50 pg/mL in mortality were 91%-80%, 77%-68%, 97.9%-62.3% and 91%-80%, respectively (AUC 0.877-0.722, p<0.001 and p=0.027, respectively). As a result, suPAR> 0.69 ng / mL can be used as a predictor of mortality in children who admit to ED with severe-sepsis and septic-shock.