1. 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.

2. 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.

3. 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.

4. 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)

5. 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 For procalcitonin ıt was found ng/mL with a sensitivity of 75.7 and spesifity Parallel assesment of Presepsin and PCT
increased sensitivity to 93 % and negative predictive value (NPV) to 91% .

6. Figure 2: Daily monitorization results for 3 days until sepsis day.
% AUC values
Presepsin
PCT
CRP
WBC
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.

7. 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

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

9. THANK YOU