PRESEPSIN AS THE EARLY MARKER OF PURULENT SEPTIC COMPLICATIONS IN PATIENTS WITH SEVERE ACUTE PANCREATITIS

• Main Authors: N. N. Salina, V. P. Nikulina, R. N. Borisov, M. A. Godkov
• Format: Article
• Language: Russian
• Published: Sklifosovsky Research Institute for Emergency Medicine, Public Healthcare Institution of Moscow Healthcare Department 2018-04-01
• Series: Neotložnaâ Medicinskaâ Pomoŝʹ
• Subjects: acute pancreatitis; presepsin; procalcitonin; pancreatic necrosis
• Online Access: https://www.jnmp.ru/jour/article/view/434
• ISSN: 2223-9022; 2541-8017

Sepsis is the leading cause of mortality in patients with severe acute pancreatitis (SAP). High mortality rate in patients with SAP is mainly associated with purulent and inflammatory process in parapancreatic fat. Early laboratory diagnosis of infection is vitally important for timely indications for surgery and successful therapy. Aim of study The comparison of prognostic and diagnostic values of presepsin and acute phase proteins (CRP, PCT) in the development of septic complications in patients with SAP at the early stage. Material and methods We examined 37 patients with SAP. Depending on the course and outcome of the disease, patients were divided into two groups: Group 1 (n=10) — deceased patients, Group 2 (n=27) — patients with a favorable outcome. Each of these groups was divided into two subgroups: 1A (n=8) — patients who died of sepsis, 1B (n=2) — patients who died of other causes, 2A (n=7) — patients with a favorable outcome of sepsis and 2B (n=20) — patients without septic complications. The PSEP level was measured with PATHFAST enzyme immunoassay analyzer (LSI Medience Corporation, Japan). Descriptive statistics of quantitative characteristics were represented by medians and quartiles (Me (LQ; UQ)), values of area under the ROC curve (AUC) and 95% confidence interval. To compare the groups, the Mann–Whitney U test was used. Results The concentration of PSEP 785 pg/ml and higher on day 2–5 from the onset of the disease indicated a significant risk of purulent complications in intensive care patients with a sensitivity of 91.2% (95% CI, 77.93–97.89) and a specificity of 77.3% (95% CI, 51.59–97.91). The area under the curve for PSEP was 0.859 (AUC). PCT — 0.804 (AUC), sensitivity — 85%, specificity — 57%. CRP — 0.718 (AUC), sensitivity — 75% and specificity — 50%. Conclusion Based on the data obtained, it can be concluded that PSEP has the most informative value and diagnostic sensitivity compared to other markers of inflammation for an early diagnosis of sepsis in patients with SAP.