Pancreatic Stone Protein Predicts Sepsis in Severely Burned Patients Irrespective of Trauma Severity

Abstract

OBJECTIVE: The burn victim's inherent state of hyperinflammation frequently camouflages septic events delaying the initiation of targeted intensive care therapy. Accurate biomarkers are urgently needed to support sepsis detection before patients' clinical deterioration. SUMMARY OF BACK-GROUND DATA: Evidence on the usefulness of pancreatic stone protein (PSP) as a powerful diagnostic and prognostic marker in critically ill patients has recently accumulated. METHODS: Analysis of biomarker kinetics (PSP, routine markers) was performed on 90 patients admitted to the Zurich Burn Center between May 2015 and October 2018 with burns 15% total body surface area with regard to infection and sepsis (Sepsis-3) over a 14-day time course. RESULTS: PSP differentiated between sepsis, infection and sterile inflammation from day 3 onward with an area under the curve of up to 0.89 (P < 0.001), therefore, competing with procalcitonin (area under the curve = 0.86, P < 0.001). Compared to routine inflammatory biomarkers, only PSP demonstrated a significant interaction between time and presence of sepsis -signifying a steeper increase in PSP levels in septic patients as opposed to those exhibiting a nonseptic course (interaction P < 0.001). Event-related analysis demonstrated tripled PSP serum levels within 72 hours and doubled levels within 48 hours before a clinically apparent sepsis. CON-CLUSION: PSP is able to differentiate between septic and nonseptic patients during acute burn care. Its steep rise up to 72 hours before clinically overt deterioration has the potential for physicians to timely initiate treatment with reduced mortality and costs.

Serial measurement of pancreatic stone protein for the early detection of sepsis in intensive care unit patients: a prospective multicentric study

“…The main novel finding of this study is the significant association of the clinical diagnosis of sepsis with the continuous increase in the PSP level in the 3 days before this diagnosis. This association corroborates the initial description of this particularity of PSP [9], recently confirmed in a cohort of patients with severe burns, in which PSP levels increased constantly in the days preceding sepsis and this increase was greater in patients with septic shock [11,23].…”

“…In an unselected cohort of critically ill adults, PSP was found to be superior to PCT and other sepsis biomarkers for the accurate identification of sepsis [10]. An increase in PSP level preceding the development of sepsis has recently been demonstrated in a cohort of severely burnt patient [11]. The diagnostic performance of PSP, alone and in combination with other markers or clinical scores, was evaluated further in several studies conducted in adults, children, and neonates, in both, intensive care units (ICUs) and emergency departments [12].…”

Serial Measurement of Pancreatic Stone Protein for the Early Detection of Sepsis in Intensive Care Unit Patients: A Prospective Multicentric Study

“…The main novel nding of this study is the signi cant association of the clinical diagnosis of sepsis with the continuous increase in the PSP level in the 3 days before this diagnosis. This association corroborates recent observations made in a cohort of patients with severe burns, in which PSP levels increased constantly in the days preceding sepsis and this increase was greater in patients with septic shock (11,22).…”

“…In an unselected cohort of critically ill adults, PSP was found to be superior to PCT and other sepsis biomarkers for the accurate identi cation of sepsis (10). An increase in PSP level preceding the development of sepsis has recently been demonstrated in a cohort of severely burnt patient (11). The diagnostic performance of PSP, alone and in combination with other markers or clinical scores, has been evaluated further in several studies conducted in adults, children, and neonates, in both, intensive care units (ICUs) and emergency departments (12).…”

Incidence and Time Point of Sepsis Detection as Related to Different Sepsis Definitions in Severely Burned Patients and Their Accompanying Time Course of Pro-Inflammatory Biomarkers

“…Originally described as a protein constitutively secreted by pancreatic acinar cells to inhibit growth and nucleation of calcium carbonate crystals, insights from more recent studies suggest PSP as acute phase protein activating neutrophil granulocytes in the early phase of infection. Our group recently published data on PSP’s excellent predictive power to detect sepsis and septic shock (Sepsis-3) in burn patients—outperforming PCT and CRP by its steeper and earlier rise prior to the critical onset of sepsis [ 18 ].…”