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Published on: June 28, 2018
Biomarker combinations in predicting sepsis in hospitalized children with fever
Linda Rautiainen1, Anna Cirko2,3, Jana Pavare2,3
1Department of Pediatrics, Riga Stradins University, Riga, LV1007, Latvia. linda.e.rautiainen@gmail.com.
Insights
Biomarkers like C-reactive protein (CRP) and cytokines show promise in identifying sepsis, a critical illness. Combining CRP with other markers, such as soluble Fas (sFAS), improves sepsis prediction accuracy.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Biochemistry
Background:
- Sepsis is a major global cause of critical illness, characterized by a dysregulated inflammatory response to infection.
- Accurate methods for early sepsis recognition and mortality prediction are crucial for patient outcomes.
- Identifying reliable biomarkers for inflammatory responses in sepsis is an ongoing challenge.
Purpose of the Study:
- To investigate and compare the predictive validity of various biomarkers for sepsis in patients presenting with fever.
- To evaluate both pro-inflammatory and anti-inflammatory markers for their diagnostic performance in sepsis.
- To explore the potential of biomarker combinations to enhance sepsis prediction.
Main Methods:
- 165 febrile patients were enrolled; 55 met sepsis criteria (pSOFA).
- Blood samples were collected at inclusion and 24 hours.
- Levels of C-reactive protein (CRP), procalcitonin (PCT), IL-6, IL-8, sFAS, and sVCAM-1 were measured.
Main Results:
- CRP, PCT, IL-6, IL-8, and sFAS levels were significantly elevated in sepsis patients.
- CRP demonstrated the highest area under the curve (AUC) of 0.799 for sepsis prediction among single markers.
- Combining CRP with sFAS improved sensitivity, and a panel including CRP, IL-6, sFAS, and sVCAM-1 achieved the highest AUC (0.830).
Conclusions:
- While CRP shows good predictive value for sepsis, combining it with other biomarkers like IL-6, sFAS, and sVCAM-1 significantly enhances diagnostic performance.
- Single cytokine markers did not exhibit significant diagnostic utility.
- Biomarker panels offer a more robust approach to identifying sepsis in febrile patients.
Abstract:
Sepsis is among the leading causes of critical illness worldwide. It includes physiologic, pathologic, and biochemical abnormalities, induced by infection. Novel methods for recognizing a dysregulated inflammatory response and predicting associated mortality must be developed. Our aim was to investigate biomarkers that characterize a pro-inflammatory and anti-inflammatory response in patients with fever by comparing predictive validity for sepsis. 165 patients with fever were enrolled in this study, 55 of them had sepsis according to pSOFA criteria. All patients had blood samples drawn at the time of inclusion and after 24 h. CRP, PCT and also IL-6, IL-8 and sFAS levels were significantly higher in patients with sepsis. The AUC of CRP to predict sepsis was 0.799, all the other biomarkers had AUC's lower than that. Cytokines, when used as a single marker, did not show a significant diagnostic performance We analyzed various models of biomarker combinations. CRP combined with sFAS showed increase in sensitivity in predicting sepsis (88% vs. 83%). The highest AUC was achieved, when CRP, IL-6, sFAS and sVCAM-1 markers were combined 0.830 (95% CI 0.762-0.884) with a sensitivity of 70% and specificity of 84%. vs. 0.799 for CRP alone.
