Yasumasa Kawano

Potential use of procalcitonin as biomarker for bacterial sepsis in patients with or without acute kidney injury

INTRODUCTION There are few investigations regarding the relationships between procalcitonin (PCT) and the acute kidney injury (AKI) in the diagnosis of sepsis. The purpose of this study was to clarify the diagnostic accuracy of the use of PCT levels in patients with or without AKI. METHODS This study was conducted as a single-center retrospective study. We enrolled 393 patients in whom PCT were measured on admission. We grouped the patients into non-AKI and AKI, and those with AKI were classified according to the RIFLE criteria (Risk, Injury, Failure). The patients in each group were further classified into the sepsis and the non-sepsis group. We subsequently investigated the diagnostic accuracy of the PCT for detecting sepsis in these groups. RESULTS The levels of PCT were significantly higher in the sepsis group than in the non-sepsis group among the non-AKI and each AKI patients (p < 0.0001). The diagnostic accuracy of the PCT for detecting sepsis was determined according to a ROC analysis; AUC value was 0.958 in the non-AKI group, in the Risk, Injury and Failure groups were 0.888 and 0.917, 0.857, respectively. AUC value for non-AKI group was significantly different from that of Failure group (p < 0.05). CONCLUSIONS In Failure AKI patients, the diagnostic accuracy of the PCT level is significantly lower than non-AKI patients. It is therefore suggested that we should be careful in using PCT value to diagnose sepsis in patients with Failure under RIFLE criteria.

Intravenous immunoglobulin improves sepsis-induced coagulopathy: A retrospective, single-center observational study

INTRODUCTION Inflammation and coagulation are closely interrelated processes in the pathogenesis of sepsis. This study aimed to determine whether intravenous immunoglobulin (IVIg) could improve the hyperinflammatory state and coagulation/fibrinolysis abnormalities in patients with sepsis. METHODS Forty-one patients with sepsis were included. Nineteen patients were treated with IVIg (IVIg group; 5.0 g daily for 3 days within 2 days after hospitalization), and 22 patients were not (non-IVIg group). Inflammatory and coagulation/fibrinolysis molecular markers, Japanese Association for Acute Medicine disseminated intravascular coagulation score, and the Sequential Organ Failure Assessment score were evaluated in each group. RESULTS On admission, patients in the IVIg group had a significantly more severe condition. In the IVIg group, after treatment, C-reactive protein, procalcitonin, and interleukin-6 levels significantly decreased relative to values on admission. Also, compared with admission, the various coagulation/fibrinolysis molecular markers decreased after treatment. Moreover, the Japanese Association for Acute Medicine disseminated intravascular coagulation score and the Sequential Organ Failure Assessment score also significantly decreased after treatment. In contrast, in the non-IVIg group, only interleukin-6 level and thrombin-antithrombin complex levels significantly decreased. The 28-day mortality rate of the IVIg group was approximately one third of the value of the non-IVIg group (IVIg: 5.3% vs non-IVIg: 18.2%). CONCLUSIONS Intravenous immunoglobulin treatment significantly improved hemostatic abnormalities along with the hyperinflammatory state in patients with sepsis. Accordingly, IVIg treatment should be classified as an adjunctive therapy for patients complicated with sepsis-induced coagulopathy.

1056: THE EFFICACY OF THE POLIMYXIN B IMMOBILIZED FIBER COLUMN DIRECT HEMOPERFUSION FOR SEPTIC SHOCK

Crit Care Med 2015 • Volume 43 • Number 12 (Suppl.) baseline and after CSE exposure. The NALP3-ubiquitin binding was increased by more than 50% after CSE exposure when densitometrically controlled for input loading. Conclusions: CSE decreases NALP3 protein levels by increasing its degradation, not by decreasing new protein synthesis. The underlying mechanism is most likely increased ubiquitin-mediated proteasomal processing. Our findings provide potential mechanistic insights for smoking-related immunosuppression, and this may uncover unique opportunities to develop therapeutic strategies to modulate cytokine signaling, and subsequently, inflammation associated with sepsis development.

Comparison of accuracy of presepsin and procalcitonin concentrations in diagnosing sepsis in patients with and without acute kidney injury

BACKGROUND Levels of the biomarkers presepsin and procalcitonin are affected by renal function. We evaluated the accuracies of presepsin and procalcitonin levels for diagnosing sepsis in patients with and without acute kidney injury (AKI). METHODS We evaluated patients with presepsin and procalcitonin data, and classified them into AKI and non-AKI groups based on the Kidney Disease Improving Global Outcomes criteria. Each group was then subdivided according to sepsis status for each stage of AKI. Receiver operating characteristic curve analyses were used to investigate the accuracies of biomarker levels for diagnosing sepsis. RESULTS In the non-AKI group, the area under the curves (AUCs) for procalcitonin and presepsin levels were 0.897 and 0.880, respectively (p = .525) and optimal cut-off values were 0.10 ng/ml (sensitivity: 85.1%, specificity: 79.1%) and 240 pg/ml (sensitivity: 80.9%, specificity: 83.2%), respectively. In the stage 3 subgroup, the AUC for procalcitonin (0.946) was significantly higher than that for presepsin (0.768, p < .001). The optimal cut-off values for diagnosing sepsis were 4.07 ng/ml (sensitivity: 87.2%, specificity: 93.5%) for procalcitonin and 500 pg/ml (sensitivity: 89.7%, specificity: 59.7%) for presepsin. CONCLUSIONS In patients with severe AKI, the accuracy of the diagnosis of sepsis with procalcitonin was significantly higher than with presepsin.

Efficacy of direct hemoperfusion with a polymyxin B-immobilized fiber column in miliary tuberculosis

A 75‐year‐old woman presented with a 10‐day history of intermittent fever, general fatigue, and progressive dyspnea. Although she had a low PaO2/FIO2 ratio, the cause of acute respiratory distress syndrome was not clear until day 9 in hospital.

1398: PLASMINOGEN ACTIVATOR INHIBITOR-1 IS THE MOST PREDICTIVE MARKER OF MORTALITY IN SEPSIS.

Learning Objectives: Sepsis has poor outcome, and the mortality rate is 30%50% in patients with septic shock. Early diagnosis and treatment of sepsis are important for improving the prognosis. Sepsis is the most common disease associated with coagulopathy. Approximately 20%-40% of all sepsis patients are complicated with disseminated intravascular coagulation (DIC). Therefore, inflammation and coagulation are closely interrelated in sepsis. In 2016, new sepsis definition named SEPSIS-3 was published. We aimed to identify the most predictive marker of 28-day mortality using inflammation and coagulation markers. Methods: This was a single-center retrospective study and included 186 patients with sepsis from January 2013 to September 2015. The definition of sepsis was used according to SEPSIS-3. Inflammatory markers [C-reactive protein (CRP), procalcitonin (PCT), and presepsin (PSEP)] and coagulation markers [platelet count, prothrombin time-international normalized ratio (PT-INR), activated partial thromboplastin time (APTT), antithrombin (AT), D-dimer, thrombin-antithrombin complex (TAT), plamin-2 plasmin inhibitor complex (PIC), protein C (PC), soluble fibrin (SF), and plasminogen activator inhibitor (PAI)-1] were assayed on ED admission. Univariate and multivariate logistic regression analyses were performed to identify independent predictive markers of 28-day mortality. The area under the curve (AUC) and the optimal cut-off value of the most predictive marker were examined. Results:The 28-day mortality rate was 19% (36/186). PSEP, TAT, PC, SF, and PAI-1 were found to be significant predictive markers of 28-day mortality according to univariate analysis. Subsequently, we performed multivariate logistic regression analysis using these five markers as explanatory variables. PAI-1 was found to be the only independent predictive marker of 28-day mortality (P <0.05). AUC of PAI-1 was 0.72, and the optimal cut-off value was 83 ng/ml, with sensitivity and specificity of 75% and 61%, respectively. Conclusions: In conclusion, PAI-1 may be a useful predictive marker of 28-day mortality for sepsis.