Accuracy of Pancreatic Stone Protein for diagnosis of sepsis in children admitted to pediatric intensive care or high-dependency care: a pilot study

Abstract

Background Pancreatic Stone Protein (PSP) is one of the most promising diagnostic and prognostic markers. The aim of the study was to assess the accuracy of PSP, compared to C-Reactive Protein (CRP), and Procalcitonin (PCT) for sepsis diagnosis in pediatric patients. Furthermore, we explored the correlation of PSP levels with sepsis severity and organ failure measured with PELOD-2 score. Methods Forty pediatric patients were enrolled following admission to pediatric intensive care, high dependency care or pediatric ward. PSP blood levels were measured in Emergency Department (nanofluidic point-of-care immunoassay; abioSCOPE, Abionic SA, Switzerland) on day 1, 2, 3, 5 and 7 from the onset of the clinical signs and symptoms of sepsis or SIRS. Inclusion criteria were: 1) patient age (1 month to 18 years old), 2) signs and symptoms of SIRS, irrespective of association with organ dysfunction. Exclusion criteria were: 1) hemato-oncological diseases and/or immunodeficiencies, 2) pancreatic diseases. Results Septic patients showed higher PSP levels than those with non-infectious systemic inflammation. The optimal cut-off in diagnosis of sepsis for PSP at day 1 was 167 ng/ml resulted in a sensitivity of 59% (95% IC 36%—79%) and a specificity of 83% (95% IC 58%-96%) with an AUC of 0.636 for PSP in comparison to AUC of 0.722 for PCT and 0.503 for C-RP. ROC analysis for outcome (survival versus no survival) has showed AUC 0.814 for PSP; AUC 0.814 for PCT; AUC of 0.657 for C-RP. Conclusions PSP could distinguish sepsis from non-infectious systemic inflammation; however, our results need to be confirmed in larger pediatric population.

Usefulness of pancreatic stone protein measurement to screen and diagnose sepsis in the context of the Surviving Sepsis Campaign recommendations.

“…Searching for clinical studies of PSP and infection or sepsis in PubMed, we identified 1 prospective multicenter study, 29 20 prospective observational studies (Table 3 and 4), 2 meta-analyses, 30,31 2 literature reviews, 32,33 1 economic study, 34 2 technology study, 35,36 1 case report, 37 3 Covid-19 studies, [38][39][40] 1 book chapter, 41 2 point-of-view articles. 42,43 From the PubMed citations, we excluded 8 children studies, [44][45][46][47][48][49][50][51] 3 neonate studies, [52][53][54] 1 post-mortem study, 55 1 study in women for pregnancy-related disease, 56 1 PSP and diabetes study, 57 2 study protocols, 58,59 1 letter, 60 1 editorial, 61 4 comments, [62][63][64][65] and 1 published erratum. 66…”