Presepsin (sCD14-ST) Is a Novel Marker for Risk Stratification in Cardiac Surgery Patients
| Autor: | Stefan Wagenpfeil, Heinrich V. Groesdonk, Thomas Volk, Hagen Bomberg, Hans Joachim Schäfers, Eberhard Spanuth, Matthias Klingele, Daniel I. Sessler |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Lipopolysaccharide Receptors 030204 cardiovascular system & hematology Preoperative care Risk Assessment Sepsis Cohort Studies 03 medical and health sciences 0302 clinical medicine Postoperative Complications Internal medicine Germany medicine Odds Ratio Humans 030212 general & internal medicine Prospective Studies Cardiac Surgical Procedures Prospective cohort study Intensive care medicine Aged business.industry Odds ratio Middle Aged medicine.disease Peptide Fragments Cardiac surgery Systemic inflammatory response syndrome Anesthesiology and Pain Medicine ROC Curve Cardiology Female business Risk assessment Biomarkers Cohort study Follow-Up Studies |
| Zdroj: | Anesthesiology. 126(4) |
| ISSN: | 1528-1175 |
| Popis: | Background Presepsin (soluble cluster-of-differentiation 14 subtype [sCD14-ST]) is a humoral risk stratification marker for systemic inflammatory response syndrome and sepsis. It remains unknown whether presepsin can be used to stratify risk in elective cardiac surgery. The authors therefore determined the usefulness of presepsin for risk stratification in patients having elective cardiac surgery. Methods Eight hundred fifty-six cardiac surgical patients were prospectively studied. Preoperative plasma concentrations of presepsin, procalcitonin, N-terminal pro–hormone natriuretic peptide, cystatin C, and the additive European System of Cardiac Operative Risk Evaluation 2 were compared to mortality at 30 days (primary outcome), 6 months, and 2 yr. Discrimination was assessed with C statistic. Logistic regression analysis was used to calculate univariable and multivariable odds ratios. Results Thirty-day mortality was 3.2%, 6-month mortality was 6.1%, and 2-yr mortality was 10.4% across the population. Median preoperative presepsin concentrations were significantly greater in 30-day nonsurvivors than in survivors: 842 pg/ml (interquartile range, 306 to 1,246) versus 160 pg/ml (interquartile range, 122 to 234); difference, 167 pg/ml (interquartile range, 92 to 301; P < 0.001). The results were similar for 6-month and 2-yr mortality. Compared to the European System of Cardiac Operative Risk Evaluation 2, presepsin concentration provided better discrimination for postoperative mortality at all follow-up periods, including 30 days (C statistic 0.88 vs. 0.74), 6 months (0.87 vs. 0.76), and 2 yr (0.81 vs. 0.74). Presepsin also provided better discrimination than cystatin C, N-terminal pro–hormone natriuretic peptide, or procalcitonin. Elevated presepsin remained an independent risk predictor after adjustment for potential confounding factors. Conclusions Elevated preoperative plasma presepsin concentration is an independent predictor of postoperative mortality in elective cardiac surgery patients and is a stronger predictor than several other commonly used assessments. |
| Databáze: | OpenAIRE |
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