Data from: Diagnostic accuracy of presepsin in predicting bacteremia in elderly patients admitted to the emergency department: prospective study in Japan

Objective Early detection of bacteremia in the elderly is needed in the emergency department (ED). Design, Setting, and Participants Prospective study in Japan, single center trial in patients who satisfied the sepsis criteria was conducted between September 2014 and March 2016. Forty-six elderly patients aged ≥70 years were included. Interventions Blood sampling to evaluate C-reactive protein (CRP), procalcitonin (PCT) and presepsin plasma levels; two sets of blood sampling for bacterial cultures; and evaluations of the Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE II) scores were performed upon arrival at the ED. The results were compared between patients with bacteremia and those without bacteremia. Main Outcome Measure The accuracy of detecting bacteremia Results The presepsin value was significantly higher in the bacteremia group than in the non-bacteremia group (866.6 ± 184.6 pg/mL vs. 639.9 ± 137.1 pg/mL, p = 0.03). The PCT and CRP did not significantly differ between the groups. The area under the receiver-operating-characteristic curve (AUC) values were not significantly different among presepsin (0.69), PCT (0.61), and CRP (0.53). Multivariate analysis showed that presepsin was independently associated with bacteremia (odds ratio, 8.84; 95% confidence interval, 0.95–81.79; p = 0.02). Conclusion Presepsin could be a good biomarker to predict bacteremia in elderly patients with sepsis criteria admitted to the ED.【研究目的】急诊科室（ED，Emergency Department）亟需对老年菌血症患者开展早期筛查。 【研究设计、场景与研究对象】本研究为前瞻性单中心研究，于日本开展，纳入2014年9月至2016年3月期间符合脓毒症诊断标准的患者，最终纳入46例年龄≥70岁的老年受试者。 【干预措施】患者抵达急诊科室后，即采集血液样本检测C反应蛋白（CRP, C-reactive protein）、降钙素原（PCT, procalcitonin）及血浆presepsin（presepsin）水平；采集两套血液标本行细菌培养；同时完成序贯器官衰竭评分（SOFA, Sequential Organ Failure Assessment）与急性生理学与慢性健康状况评分II（APACHE II, Acute Physiology and Chronic Health Evaluation II）的评估，随后对比菌血症患者与非菌血症患者的各项检测结果。 【主要结局指标】本研究的主要结局指标为菌血症筛查的准确性。 【研究结果】菌血症组的血浆presepsin水平显著高于非菌血症组（866.6 ± 184.6 pg/mL vs. 639.9 ± 137.1 pg/mL，p=0.03）；两组的降钙素原与C反应蛋白水平无显著差异。受试者工作特征曲线下面积（AUC, area under the receiver-operating-characteristic curve）分别为presepsin（0.69）、PCT（0.61）及CRP（0.53），三者间无统计学差异。多因素回归分析显示，血浆presepsin水平与菌血症存在独立相关性（优势比：8.84；95%置信区间：0.95~81.79；p=0.02）。 【研究结论】血浆presepsin可作为急诊就诊的符合脓毒症诊断标准的老年患者菌血症预测的优良生物标志物。