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      An evaluation of clinical inflammatory and coagulation markers in patients with sepsis: a pilot study

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          Abstract

          Aim

          Presepsin values could assist early diagnosis and prognosis of sepsis. In sepsis, prognosis is determined according to multiple organ dysfunction, where coagulopathy is common and associated with prognosis. This study aimed to determine the correlation between presepsin value trend and prognosis, and investigate coagulation abnormality in sepsis.

          Methods

          We retrospectively examined 18 intensive care unit patients diagnosed with sepsis whose presepsin values at admission were ≥500 ng/mL. If presepsin values had decreased ≥50% on hospital day 6, compared to admission values, the patient was allocated into a decreased presepsin group.

          Results

          Presepsin values in non‐survivors with sepsis were significantly higher than in survivors on day 6 ( P = 0.022). No significant differences in procalcitonin or C‐reactive protein were identified between survivors and non‐survivors, and platelet counts were significantly lower in non‐survivors on days 0, 3, and 6 ( P = 0.001, P < 0.001, and P = 0.001, respectively). The 90‐day mortality rate in a decreased presepsin group significantly improved, even when presepsin values were high on admission ( P = 0.012). Platelet counts were significantly lower on all hospital days in the non‐decreased presepsin group.

          Conclusion

          Fifty percent decrease in presepsin levels could be a useful prognostic predictor of sepsis. Larger studies are required to confirm our findings.

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          Most cited references16

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          KDIGO Clinical Practice Guidelines for Acute Kidney Injury

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            Thrombocytopenia and prognosis in intensive care.

            To study the incidence and prognosis of thrombocytopenia in adult intensive care unit (ICU) patients. Prospective observational cohort study. The medical ICU of a university hospital and the combined medical-surgical ICU of a regional hospital. All patients consecutively admitted during a 5-month period. Patient surveillance and data collection. The primary outcome measure was ICU mortality. Data of 329 patients were analyzed. Overall ICU mortality rate was 19.5%. A total of 136 patients (41.3%) had at least one platelet count 150 x 10(9)/L (p < .0005 for all comparisons). Bleeding incidence rose from 4.1% in nonthrombocytopenic patients to 21.4% in patients with minimal platelet counts between 101 x 10(9)/L and 149 x 10(9)/L (p = .0002) and to 52.6% in patients with minimal platelet counts <100 x 10(9)/L (p < .0001). In all quartiles of admission APACHE II and SAPS II scores, a nadir platelet count <150 x 10(9)/L was related with a substantially poorer vital prognosis. Similarly, a drop in platelet count to < or =50% of admission was associated with higher death rates (OR, 6.0; 95% CI, 3.0-12.0; p < .0001). In a logistic regression analysis with ICU mortality as the dependent variable, the occurrence of thrombocytopenia had more explanatory power than admission variables, including APACHE II, SAPS II, and MODS scores (adjusted OR, 4.2; 95% CI, 1.8-10.2). Thrombocytopenia is common in ICUs and constitutes a simple and readily available risk marker for mortality, independent of and complementary to established severity of disease indices. Both a low nadir platelet count and a large fall of platelet count predict a poor vital outcome in adult ICU patients.
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              Presepsin (soluble CD14 subtype) and procalcitonin levels for mortality prediction in sepsis: data from the Albumin Italian Outcome Sepsis trial

              Introduction Sepsis, a leading cause of death in critically ill patients, is the result of complex interactions between the infecting microorganisms and the host responses that influence clinical outcomes. We evaluated the prognostic value of presepsin (sCD14-ST), a novel biomarker of bacterial infection, and compared it with procalcitonin (PCT). Methods This is a retrospective, case–control study of a multicenter, randomized clinical trial enrolling patients with severe sepsis or septic shock in ICUs in Italy. We selected 50 survivors and 50 non-survivors at ICU discharge, matched for age, sex and time from sepsis diagnosis to enrollment. Plasma samples were collected 1, 2 and 7 days after enrollment to assay presepsin and PCT. Outcome was assessed 28 and 90 days after enrollment. Results Early presepsin (day 1) was higher in decedents (2,269 pg/ml, median (Q1 to Q3), 1,171 to 4,300 pg/ml) than in survivors (1,184 pg/ml (median, 875 to 2,113); P = 0.002), whereas PCT was not different (18.5 μg/L (median 3.4 to 45.2) and 10.8 μg/L (2.7 to 41.9); P = 0.31). The evolution of presepsin levels over time was significantly different in survivors compared to decedents (P for time-survival interaction = 0.03), whereas PCT decreased similarly in the two groups (P = 0.13). Presepsin was the only variable independently associated with ICU and 28-day mortality in Cox models adjusted for clinical characteristics. It showed better prognostic accuracy than PCT in the range of Sequential Organ Failure Assessment score (area under the curve (AUC) from 0.64 to 0.75 vs. AUC 0.53 to 0.65). Conclusions In this multicenter clinical trial, we provide the first evidence that presepsin measurements may have useful prognostic information for patients with severe sepsis or septic shock. These preliminary findings suggest that presepsin may be of clinical importance for early risk stratification.
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                Author and article information

                Contributors
                riki1020@belle.shiga-med.ac.jp
                Journal
                Acute Med Surg
                Acute Med Surg
                10.1002/(ISSN)2052-8817
                AMS2
                Acute Medicine & Surgery
                John Wiley and Sons Inc. (Hoboken )
                2052-8817
                01 March 2019
                April 2019
                : 6
                : 2 ( doiID: 10.1002/ams2.2019.6.issue-2 )
                : 158-164
                Affiliations
                [ 1 ] Department of Critical and Intensive Care Medicine Shiga University of Medical Science Otsu Shiga Japan
                Author notes
                [*] [* ]Corresponding: Emi Fujii, MD, Department of Critical and Intensive Care Medicine, Shiga University of Medical Science, Seta‐tsukinowa‐cho, Otsu, Shiga 520‐2192, Japan. E‐mail: riki1020@ 123456belle.shiga-med.ac.jp .
                Author information
                https://orcid.org/0000-0001-8115-7146
                Article
                AMS2397
                10.1002/ams2.397
                6442531
                37650cab-6e8d-4152-905f-64f0fd0c0046
                © 2019 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 09 October 2018
                : 27 January 2019
                Page count
                Figures: 3, Tables: 2, Pages: 7, Words: 3684
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                ams2397
                April 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.2.1 mode:remove_FC converted:01.04.2019

                c‐reactive protein,platelet count,presepsin,procalcitonin,prognosis

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