Arginase and Procalcitonin: Promising Biomarkers for Early Diagnosis of Sepsis

Abstract

Introduction: Sepsis remains a major cause of death in critically ill patients in Indian population because of high susceptibility towards infectious diseases in the world. Procalcitonin (PCT) is a well-studied marker in foreign countries but needs to be established in Indian population. In the last few years, importance of Arginase as a marker of immunity has also increased exceptionally, because this enzyme is essentially involved in different inflammatory processes. Keeping these facts in mind PCT and Arginase were evaluated for their utility as markers to diagnose sepsis. Aim: To evaluate Arginase and PCT as biomarkers for early diagnosis of sepsis. Materials and Methods: Hundred adult patients (age >18 years) with Systemic Inflammatory Response Syndrome (SIRS) attending BJ Medical College which is affiliated with Sassoon General Hospital (Pune, Maharashtra, India) during May 2012-July 2015 were incorporated in the study. Age n sex-matched of 100 samples healthy controls were also collected. Arginase was estimated by Roman and Ray method and PCT by Enzyme-linked Immunosorbent Assay Kit (ELISA) method. Unpaired t-test was done to compare the mean biomarker levels between the cases and controls. The Area Under Curve (AUC) was calculated using Receiver Operating Curve (ROC). All the data analysis was set at 95% Confidence Interval (CI) and value p<0.05 are statistically significant. Data analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. Results: In the study, a significant increase was observed in the levels of arginase (p<0.01) and PCT (p<0.01) in cases as compared to controls. ROC curves were plotted to find out the cut-offs of arginase (4.6 IU/L) and PCT (0.04 ng/mL) to check the diagnostic efficacy of both the biomarkers. Conclusion: Serum PCT and arginase offers a high level of accuracy than other currently available tests and hence can be helpful in the management of sepsis. In addition to this apart from high sensitivity and specificity arginase estimation is cost effective as compared to PCT.