EVALUATION OF SOLUBLE CD14 SUBTYPE (PRESEPSIN) IN BURN SEPSIS Madenci OCa, Yakupoğlu Sb, Benzonana Nc, Yücel Na, Akbaba Da, Orçun A a Dr. Lütfi Kırdar Kartal Research and Training Hospital, İstanbul, Turkey. a Biochemistry Laboratory, b Burn Center Anaesthesia and Reanimation Clinic, c Infectious Diseases and Clinical Microbiology This is the first study evaluating presepsin (soluble CD 14 subtype) in burn sepsis using ABA (American Burn Association) Consensus Criteria.

BACKGROUND Diagnosis according to ABA(American Burn Association) Consensus Criteria 2007 Soluble CD14 subtype (Presepsin) is compared with procalcitonin (PCT), CRP and WBC in burn patients. Diagnosis and follow up of sepsis is difficult in burn patients because of the inflammatory mediators altering postburn metabolic profile. ABA revised and published new criteria in 2007 for a more standart definition of sepsis. Here we compared presepsin with traditional markers PCT, CRP and WBC in burn sepsis diagnosed according to ABA.

METHOD A prospective study 37 adult patients. Sepsis and non sepsis groups according to ABA 2007 371 non septic, 240 septic time points. Presepsin, PCT, CRP and WBC levels. 37 adult patients admitted to burn center of our institude were prospectively investigated. At all timing samples, patients were classified as sepsis or non-sepsis according to the current criteria. Presepsin, PCT, CRP and WBC levels were measured at admission and every 6 hours for first day and daily thereafter. 371 non-septic and 240 septic points were evaluated.

RESULTS Table:1 Results of sepsis and non- sepsis groups. Sepsis P value n (time points) Presepsin 240 847 371 332 P<0.0001 PCT 2.04 0.293 P=0.0012 CRP 133 52 WBC 13200 12000 P=0.9902 Presepsin, PCT, and CRP levels of sepsis and non-sepsis time points differed significantly from each other, no significant difference was found for WBC levels. Presepsin; (pg/mL), PCT ; (ng/mL), CRP;(mg/L), WBC; (/μL)

RESULTS Table:4 Diagnostic performance of presepsin, PCT, CRP and WBC in sepsis, using ROC curves. Presepsin PCT CRP WBC Optimum cut-off value 542 0.759 65 13700 AUC-ROC 83,4 84,7 81.9 50.8 Sensitivity (%) 77.3 75.7 91.6 49 Spesificity(%) 76.4 78.6 58.2 61.7 PPV (%) 72.3 73.6 62.1 45.2 NPV (%) 80.7 80.3 90.2 65.1 (PPV:Positive predictive value, NPV:Negative predictive value) Presepsin; (pg/mL), PCT ; (ng/mL), CRP;(mg/L), WBC; (/μL) Optimum cut-off value was found 542 pg/mL for presepsin with a sensitivity of 77.3 % and spesifity 76.4. For procalcitonin ıt was found 0.759 ng/mL with a sensitivity of 75.7 and spesifity 78.6. Parallel assesment of Presepsin and PCT increased sensitivity to 93 % and negative predictive value (NPV) to 91% .

Figure 2: Daily monitorization results for 3 days until sepsis day. % AUC values Presepsin 83.4 PCT 84.7 CRP 81.9 WBC 50.8 Diagnostic efficiencies of PCT and Presepsin were similar and both were superior to CRP; but WBC was found inefficient. Presepsin and CRP values showed gradual increases through 3 days with significant differences, High WBC levels showed dramatic decrease on the sepsis day thus overlapping WBC levels were rather confusing in follow up of patients. Unfortunately PCT remained unchanged. Figure 2: Daily monitorization results for 3 days until sepsis day. Figure:1 ROC curves of 4 markers in sepsis.

CONCLUSION Presepsin an efficient marker in sepsis diagnosis. Presepsin, PCT and CRP similar diagnostic efficiencies. Presepsin and CRP early indicators. In this study we concluded that presepsin is an efficient marker in sepsis. Presepsin, PCT and CRP showed similar diagnostic efficiencies. Presepsin and CRP can be used as early indicatiors of sepsis. Because of the complexity of septic response, ıt is unlikely that a single biomarker will sufficiently be used in clinical practice. a combination of several biomarkers and using serial measurements instead of absolute cut off points is recommended

RECOMMENDATION Use of combination of several biomarkers and serial measurements instead of absolute cut off points.

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