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Background: Sepsis is a condition prevalent among hospitalized patients which carries a high risk of morbidity and mortality. Rapid recognition of sepsis as the cause of deterioration is desirable, and then effective treatment can be initiated rapidly. Traditionally, diagnosis was based on the presence of two or more positive SIRS criteria due to infection. However, recently published sepsis-3 criteria put more emphasis on organ dysfunction caused by infection in the definition of sepsis. Regardless of this, no gold standard for diagnosis exists, and clinicians still rely on a number of traditional and novel biomarkers to discriminate between patients with and without infection, as the cause of deterioration. The present study aims to observe the changes of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and presepsin (sCD14-ST) 1evels in plasma of sepsis patients and explore the diagnosis and prognosis of sepsis.
Methods: Sixty patients with sepsis admitted to the Department of Critical Care medicine in Hainan General Hospital from October 2013 to March 2019 were selected as the experimental group. Also chosen in the same period were 60 cases of hospitalized non-sepsis patients as a control group. Plasma levels of sTREM-1 and presepsin were determined by enzyme-linked immunosorbent assay (ELISA) in the 60 patients with sepsis and the 60 non-sepsis patients. Changes of sTREM-1 and presepsin plasma 1evels were observed in the survival subgroup and non-survival subgroup of the patients with sepsis on days 1, 4, 7, and the day of discharge or death.
Results: Plasma levels of sTREM-1 and presepsin in the patients with sepsis were higher than those in the control group on the day of admission (p < 0.01). The levels of sTREM-1 and presepsin in the septic shock group were significantly higher than those in the sepsis group (p < 0.01). Plasma levels of sTREM-1 and presepsin showed a decreasing trend in the survival subgroup of the patients with sepsis, while maintaining high 1evels or increased in the subgroup of non-survivors. At different time points, the plasma levels of sTREM-1 and presepsin of the subgroup of non-survivors were all significantly higher than the subgroup of survivors. There was a significant positive correlation between plasma 1evels of sTREM-1 and presepsin (r = 0.596, p < 0.01). According to the plasma sTREM-1, presepsin, CRP, and PCT levels on the first day of enrollment in patients with sepsis, ROC curve analysis was performed and AUC was calculated. The results showed that the AUC values of sTREM-1 and presepsin were relatively high, which was 0.925 and 0.910, respectively. The AUC of PCT and CRP were slightly lower, which was 0.861 and 0.816, respectively (p < 0.01).
Conclusions: ROC curve was used to study the value of sTREM-1 and presepsin in the diagnosis of sepsis, which suggested that sTREM-1 and presepsin should be significantly superior to CRP and PCT levels. The sTREM-1 combined with presepsin had the highest AUC. sTREM-1 has been shown to have an optimal threshold of 125.00 pg/mL for the diagnosis of sepsis, the specificity was 86.0% and the sensitivity was 87.0%. Presepsin has been shown to have an optimal threshold of 1,025.00 pg/mL for the diagnosis of sepsis, the specificity was 83.0% and the sensitivity was 85.0%. The sTREM-1 and presepsin plasma levels have great reference value for the diagnosis of sepsis, and the sTREM-1 and presepsin plasma levels are relative to the severity of sepsis. It is helpful to evaluate treatment effect and prognosis of sepsis by dynamically monitoring the plasma 1evels of sTREM-1 and presepsin.
DOI: 10.7754/Clin.Lab.2019.190508
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