Combination of sepsis biomarkers may indicate an invasive fungal infection in haematological patients

Yang

Clinical Laboratory Analysis

et al. 2020

Background:The role of serum cytokines/chemokines in early diagnosis of fungal infections has not been clearly clarified yet. This study aims to measure the serum levels of cytokines/chemokines in cases of fungemia and to compare them with culture-negative controls. Methods:In total, fourteen types of serum cytokines and chemokines from 41 patients with fungemia were compared with 57 patients with negative blood culture results. The cytokine and chemokine levels were detected with multiplex platform.We then performed statistical analysis as a two-tailed P < .05. ROC analysis was performed, and an area under the curve (AUC), and sensitivity and specificity values were calculated to determine the efficacy of various cytokines and chemokines for fungemia. Binary logistic regression was performed to further explore the combination mode of cytokines and chemokines, which could increase the diagnostic efficiency.Results: C-reactive protein and procalcitonin were significantly higher compared with those in negative control group, while white blood cell, percentage of neutrophil, percentage of lymphocyte, and ratio of neutrophil and lymphocyte did not differentiate between two groups. Serum levels of IFN-γ, TNF-α, MIP-1β, IL-6, IL-8, IL-10, IL-12p70, and IL-17 were significantly higher in patients with fungemia compared with the control group. Combination of MIP-1β and IL-17 could improve the AUC, sensitivity, and specificity for the diagnosis of fungemia. Conclusion:Our study demonstrates that serum cytokines and chemokines including IFN-γ, TNF-α, MIP-1β, IL-6, IL-8, IL-10, IL-12p70, and IL-17 could be considered as diagnostic markers for fungemia. Combination of these biomarkers might improve the diagnostic efficiency of fungemia. Diagnostic efficacy of serum cytokines and chemokines in fungal bloodstream infection in febrile patients.

Section: Discussionmentioning

confidence: 47%

“…As reported by previous studies, serum CRP and PCT levels may be useful for differential diagnosis of sepsis and CRP levels were lower in patients with fungemia than those with bacteremia . In another study, “low PCT and high CRP” were found in case of fungal infections …”

Section: Discussionmentioning

confidence: 57%

Diagnostic efficacy of serum cytokines and chemokines in fungal bloodstream infection in febrile patients

Yang

Clinical Laboratory Analysis

et al. 2020

“…Furthermore, some studies provide preliminary evidence that in certain settings presepsin may be a superior diagnostic and prognostic biomarker of sepsis compared to the more common biomarkers CRP and PCT [8,22,60,61]. Other studies also emphasize the role of presepsin in the assessment of sepsis in combination with commonly used biomarkers and clinical rating scales, as part of a multi-biomarker approach of sepsis in view of the absence of the 'ideal' biomarker [6,13,28,33]. Presepsin is a promising biomarker for the evaluation of sepsis both in the emergency department to aid in the initial assessment of the patient and in the intensive care setting where patients are most likely to be in a state of multiple organ failure [34,39,40,62].…”

Section: Discussionmentioning

confidence: 99%

“…Presepsin was found to be an accurate biomarker for sepsis in geriatric individuals over 75 years of age in combination with PCT and the early warning score [ 26 ]. It was also useful for the diagnosis of bacteremia in hematological patients undergoing stem cell transplant with a cutoff value of 218 pg/ml [ 27 ] and in another study of hematological patients undergoing chemotherapy was found useful for the differentiation between bacterial and fungal infection [ 28 ]. This study confirmed the relative specificity of presepsin for bacterial infection and the authors that elevated CRP in conjunction with presepsin within the normal reference range was in favor of fungal infection in this group of immunocompromized individuals.…”

Section: Reviewmentioning

confidence: 99%

Presepsin as a Diagnostic and Prognostic Biomarker in Sepsis

Velissaris¹,

Zareifopoulos²,

Karamouzos³

et al. 2021

Cureus

Sepsis is a condition characterized by high morbidity and mortality which is commonly encountered in an emergency and critical care setting. Despite a substantial body of research, the ideal biomarker for the diagnosis and prognostic stratification of septic patients remains unknown. This review aimed to summarize the publications referring to the validity of the biomarker presepsin when used for the detection, monitoring and prognosis in patients suffering with sepsis. This work is a narrative review based on a PubMed/Medline search conducted in order to identify all relevant publications referring to the use of presepsin in sepsis. Search was not limited by year of publication so all articles archived in the database would be retrieved. No article from before 2010 was identified.A total of 57 publications of the last decade were included, all of which support the use of presepsin as a biomarker for the assessment of septic patients. It has been used alone or in combination with commonly used biomarkers in the evaluation of patients with sepsis in settings such as the emergency department and the intensive care unit. It is useful in the initial workup of patients with suspected sepsis in the emergency setting and may be a predictive factor of mortality and the most severe complication of sepsis.Presepsin seems to be a valuable tool for the laboratory workup of sepsis, especially when used in conjunction with other biomarkers and clinical rating scores with an established role in this population. Further research is needed to evaluate the clinical implications of utilizing presepsin measurements in the workup of sepsis.

“…In this category of patients, more recently in 2019, several studies have demonstrated the usefulness of P-SEP in combination with PCT and C-RP in the diagnosis of bacterial and fungal infections. Stoma et al reported that in hematological patients undergoing stem cell transplantation a cutoff of 218 ng/L is indicative of bacteremia [ 71 ], while elevation of C-RP associated with plasma P-ESP in the normal range predicts a fungal infection in immunocompromised patients [ 50 ]. Other studies have confirmed that a fungal infection can be predicted by the combination of increased P-SEP plasma levels with little or no alteration in PCT [ 72 ] and that plasma PSP levels are related to the severity of sepsis [ 73 ].…”

Section: Current Data On Presepsin As a Biomarker For Sepsismentioning

confidence: 99%

Presepsin as Early Marker of Sepsis in Emergency Department: A Narrative Review

et al. 2021

The diagnosis and treatment of sepsis have always been a challenge for the physician, especially in critical care setting such as emergency department (ED), and currently sepsis remains one of the major causes of mortality. Although the traditional definition of sepsis based on systemic inflammatory response syndrome (SIRS) criteria changed in 2016, replaced by the new criteria of SEPSIS-3 based on organ failure evaluation, early identification and consequent early appropriated therapy remain the primary goal of sepsis treatment. Unfortunately, currently there is a lack of a foolproof system for making early sepsis diagnosis because conventional diagnostic tools like cultures take a long time and are often burdened with false negatives, while molecular techniques require specific equipment and have high costs. In this context, biomarkers, such as C-Reactive Protein (CRP) and Procalcitonin (PCT), are very useful tools to distinguish between normal and pathological conditions, graduate the disease severity, guide treatment, monitor therapeutic responses and predict prognosis. Among the new emerging biomarkers of sepsis, Presepsin (P-SEP) appears to be the most promising. Several studies have shown that P-SEP plasma levels increase during bacterial sepsis and decline in response to appropriate therapy, with sensitivity and specificity values comparable to those of PCT. In neonatal sepsis, P-SEP compared to PCT has been shown to be more effective in diagnosing and guiding therapy. Since in sepsis the P-SEP plasma levels increase before those of PCT and since the current methods available allow measurement of P-SEP plasma levels within 17 min, P-SEP appears a sepsis biomarker particularly suited to the emergency department and critical care.