IntroductionSepsis, a leading cause of death in critically ill patients, is the result of complex interactions between the infecting microorganisms and the host responses that influence clinical outcomes. We evaluated the prognostic value of presepsin (sCD14-ST), a novel biomarker of bacterial infection, and compared it with procalcitonin (PCT).MethodsThis is a retrospective, case–control study of a multicenter, randomized clinical trial enrolling patients with severe sepsis or septic shock in ICUs in Italy. We selected 50 survivors and 50 non-survivors at ICU discharge, matched for age, sex and time from sepsis diagnosis to enrollment. Plasma samples were collected 1, 2 and 7 days after enrollment to assay presepsin and PCT. Outcome was assessed 28 and 90 days after enrollment.ResultsEarly presepsin (day 1) was higher in decedents (2,269 pg/ml, median (Q1 to Q3), 1,171 to 4,300 pg/ml) than in survivors (1,184 pg/ml (median, 875 to 2,113); P = 0.002), whereas PCT was not different (18.5 μg/L (median 3.4 to 45.2) and 10.8 μg/L (2.7 to 41.9); P = 0.31). The evolution of presepsin levels over time was significantly different in survivors compared to decedents (P for time-survival interaction = 0.03), whereas PCT decreased similarly in the two groups (P = 0.13). Presepsin was the only variable independently associated with ICU and 28-day mortality in Cox models adjusted for clinical characteristics. It showed better prognostic accuracy than PCT in the range of Sequential Organ Failure Assessment score (area under the curve (AUC) from 0.64 to 0.75 vs. AUC 0.53 to 0.65).ConclusionsIn this multicenter clinical trial, we provide the first evidence that presepsin measurements may have useful prognostic information for patients with severe sepsis or septic shock. These preliminary findings suggest that presepsin may be of clinical importance for early risk stratification.

Utility of presepsin (sCD14-ST) as a diagnostic and prognostic marker of sepsis in the emergency department, Clinica Chimica Acta (2015), doi: 10.1016/j.cca.2015.08.013 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. AbstractBackground: Presepsin (PSEP) is released during infectious diseases and can be

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The effects of moderate 30-min cycle ergometer exercise (aerobic metabolism) followed by short-term exercise at maximal capacity (anaerobic metabolism) on fibrinolytic activity were investigated in ten female and ten male healthy, untrained subjects. The following parameters of fibrinolytic activity were measured initially (t0), at the end of the aerobic phase (t1), at the end of the anaerobic phase (t2) and after a 30-min recovery period (t3): tissue plasminogen activator (PAt) activity, PAt concentration, plasminogen activator (PAt) activity, PAt concentration, plasminogen activator inhibitor (PAi) activity, and D-Dimer concentration. Moderate long-term exercise caused a slight but significant increase in PAt concentration and PAt activity (t1; P < 0.01), whereas short-term exercise at maximal capacity (t2) produced a substantial elevation in both these parameters (P < 0.01). This would suggest that PAt was not inhibited totally by PAi which would itself seem to be consumed during exercise. In addition, a slight exercise intensity-dependent increase in D-Dimer concentration was measured--circumstancial evidence not only for elevated fibrinolytic potential, but also for an actual increase in fibrin degradation (t2: P < 0.01). After t3 both PAt activity and D-Dimer concentration were still slightly but significantly increased. The results obtained in the tests of fibrinolytic activity showed no significant difference between the men and the women. It would seem that the release of PAt is more markedly stimulated by short-term intense physical exercise than by long-term moderate exercise and actually causes increased fibrin degradation.

The performance evaluation of automated assays for beta-CrossLaps, N-MID-Osteocalcin and intact parathyroid hormone in the BIOROSE multicenter study showed that the participating laboratories had no problems in setting up these methods and they yielded results for precision and accuracy that are superior to results achieved in external quality assessment schemes for manually performed methods. In addition, at the clinically important decision level of the upper limit of the normal range, all three tested analytes gave precise results that improved medical decisions.