Background: Sepsis, a serious condition caused by infection, can ultimately progress to life-threatening septic shock and multiple organ failure. Hitherto, no reliable markers could be used for the early diagnosis and sepsis is still a challenge for clinicians. We investigated the potential role of thymidine phosphorylase (TYMP) in infection and delved its value in diagnosing sepsis and disseminated intravascular coagulation (DIC). Methods: This prospective study enrolled infection patients consecutively admitted to Beijing Friendship Hospital from November 2019 to January 2021. Non-infection volunteers were used as control (NIC). Blood sample were obtained on day 1, 2, 4, and 7 after admission. TYMP serum levels and its correlation with DIC scores, Sequential Organ Failure Assessment (SOFA) scores, and other laboratory parameters were analyzed using the non-parametric Mann-Whitney U test and the Spearman's Rank-Order Correlation analyses. Results: Eighty-three infectious patients were enrolled. Forty-two patients were diagnosed as sepsis (SP) and 41 were non-septic infection (NSP). NIC group included 20 individuals without any infection. Serum TYMP levels were significantly higher in both SP and NSP groups when compared with the NIC group. TYMP serum levels was further higher in the SP than in the NSP group. The increase of TYMP was positively correlated with DIC scores. TYMP was higher in patients with DIC than those patients without DIC. A positive correlation presented between serum TYMP and plasma D-dimer levels. No positive correlations were found between TYMP and inflammatory markers. TYMP was higher in patients with SOFA score > 1 than those with SOFA score zero. The increase of TYMP is also positively correlated with SOFA score and death risk coefficient, and negatively correlated with oxygen index. By conducting receiver operating characteristic curve analyses, we found TYMP has a specific and sensitive predictive value for diagnosing sepsis and a modest value for DIC. Conclusions: This study is the first time to determine the role of TYMP in infectious disease. TYMP is significantly increased in infectious patients and is further higher in patients with sepsis or DIC. TYMP is positively correlated with acuity markers and has a diagnostic and prognostic value for sepsis and DIC.

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Background: Long-term use of antibiotics for septic patients leads to antibiotic resistance. This study aimed at assessing the benefit and safety of an emerging biomarker presepsin on guiding antibiotic courses for patients with sepsis. Methods: In this multicenter prospective cohort trial, patients were assigned to the presepsin or control groups. In the presepsin group, antibiotics were ceased based on predefined cut-off ranges of presepsin concentrations. The control group stopped antibiotics according to international guidelines. The primary endpoints were the number of days without antibiotics within 28 days (superiority analysis) and mortality at 28 and 90 days (non-inferiority analysis). The margin of non-inferiority was 10%.Results: Overall, 656 out of an initial 708 patients were eligible and assigned to the presepsin group (n=327) or the control group (n=329). Patients in the presepsin group had significantly more days without antibiotics than those in the control group (14.54 days [SD 9.01] vs 11.01 days [SD 7.73]; absolute difference 3.64 days, p =0.000). Mortality in the presepsin group was non-inferior to that in the control group at days 28 (17.7% vs 18.2%; absolute difference -0∙5%, 90% CI -5.4 to 4.4) and 90 (19.9% vs 19.5%; 0.4%, -4.7 to 5.5). Patients in the presepsin group had a significantly shorter mean length of stay in the hospital and lower hospitalization costs than control subjects.Conclusions: Presepsin guidance reduces the duration of antibiotic treatment in patients with sepsis without increasing mortality. Trial registration: ChiCTR, ChiCTR1900024391. Registered 9 July 2019. Retrospectively registered.