Diagnostic and prognostic value of Decoy Receptor and Presepsisn in patients with sepsis
Project no. 22771 · Status: Kapanmış (Yayın bekleniyor) · 2021
Summary
<p><strong>Aim</strong>: Sepsis is a condition caused by an infection that can progress to organ failure and death. While survival rates increase significantly with early diagnosis and treatment in sepsis patients, the chance of survival decreases by 7.6% for each hour of delay in treatment. There is a need for biomarkers that can be used for early diagnosis of sepsis, that are minimally affected by non-sepsis conditions, and can also guide prognosis in sepsis. In this study, we aimed to demonstrate the value of Decoy receptor 3 (DcR3) and presepsin in the diagnosis of sepsis patients, determination of sepsis severity, and prognosis. Additionally, we aimed to demonstrate the effectiveness of inter-day changes in the levels of DcR3 and presepsin in distinguishing between sepsis and septic shock and predicting mortality.</p><p><strong>Materials and methods</strong>: This study included 100 patients hospitalized in the Ege University Faculty of Medicine Internal Medicine and Anesthesia Reanimation intensive care units between April 2021 and December 2022, and a healthy control group (n=30). Patients were divided into two groups according to sepsis-3 criteria: sepsis (n=57) and septic shock (n=43). In addition, patients were divided into two groups, survivors (n=70) and non-survivors (n=30) according to 28-day mortality. DcR3, presepsin, biomarkers routinely used in sepsis, and lactate and SOFA score, which are included in sepsis-3 criteria were compared between groups. ROC analyses were performed for parameters with significant differences between groups and area under the curve (AUC, 95% confidence interval), and cut-off values were determined. Changes in biomarkers over days were analyzed with the Brunner-Langer model. Logistic regression analysis was performed to determine independent risk factors for 28-day mortality. p<0.05 was considered statistically significant.</p><p><strong>Results</strong>: There was no significant difference in DcR3 values between the control and patient (sepsis and septic shock) groups (p>0.05), while presepsin, CRP and PCT values were significantly higher in the patient group (p <0.001, <0.001, <0.001, respectively). In the diagnosis of sepsis, CRP showed maximum, presepsin and PCT showed excellent performance (AUCs were 1.000, 0.962, and 0.988, respectively). There was no significant difference in DcR3 and CRP values between sepsis and septic shock groups, presepsin, PCT, lactate and SOFA scores were significantly higher in the septic shock group (p <0.001, <0.001, <0.001 and 0.001, respectively). Lactate performed excellently in predicting disease severity, and presepsin, PCT, and SOFA scores performed moderately (AUCs were 0.920, 0.748, 0.711, and 0.781, respectively). The 28-day mortality was 17.5% in the sepsis group and 46.5% in the septic shock group. There was no significant difference in DcR3, presepsin, CRP, and PCT values between survivors and non-survivors, while lactate and SOFA scores were significantly higher in non-survivors (p <0.001 and <0.001, respectively). Lactate and SOFA scores performed moderately in determining prognosis (AUC 0.719 and 0.724, respectively). When changes in biomarkers were analyzed from admission to day 7, it was found that presepsin values tended to decrease in survivors and remained constant in non-survivors [p(interaction)=0.039]. Prothrombin time, urea, lactate, and female gender were independent risk factors for 28-day mortality in patients with sepsis and septic shock.</p><p><strong>Conclusion</strong>: Considering that presepsin shows excellent performance similar to CRP and PCT, outperforms CRP and PCT in the determination of sepsis severity, and its usefulness in determining prognosis through changes over days; it may be an alternative to CRP and PCT and its use in combination with these two biomarkers may be beneficial. However, it was found that DcR3 is not useful in the diagnosis and severity determination of sepsis.</p><p><strong>Keywords</strong>: sepsis; septic shock; Decoy receptor 3; presepsin</p>