Pediatric sepsis diagnostic and prognostic biomarkers: pancreatic stone protein, copeptin, and apolipoprotein A-V

Abstract

Background We assessed serum concentrations of pancreatic stone protein (PSP), copeptin, and apolipoprotein A-V (APOA5) biomarkers for the diagnosis and prognosis of pediatric sepsis, a condition associated with high mortality. Methods This prospective study included 180 children admitted to the Pediatric Intensive Care Unit and 100 healthy controls at Menoufia University Hospital. Pediatric Risk of Mortality (PRISM), Pediatric Index of Mortality-2 (PIM2), and Pediatric Sequential Organ Failure Assessment (pSOFA) scores were calculated. Serum PSP, copeptin and APOA5 were measured once within 24 h of admission. Results PSP, copeptin, and APOA5 were significantly higher in the patients than in the controls (p < 0.001). PSP and copeptin were increased among children who required mechanical ventilation (MV), had multiple organ dysfunctions, and were non-survivors, but APOA5 was decreased in those children. Logistic regression analyses showed that high pSOFA, high PSP and copeptin, low APOA5, and use of MV were associated with mortality. The receiver operating characteristic revealed that the area under the curve (AUC) for APOA5, copeptin, and PSP (0.965, 0.960, and 0.868, respectively) demonstrated high sensitivity (96%, 94%, and 80%) for sepsis diagnosis. The AUC values for PSP, copeptin, and APOA5 were 0.709, 0.705, and 0.571, respectively, with sensitivities of 74%, 58%, and 58% for mortality prediction. Conclusions PSP, copeptin, and APOA5 are promising diagnostic biomarkers for pediatric sepsis but inadequate predictors of mortality. Impact Apolipoprotein A-V (APOA5), copeptin, and pancreatic stone protein (PSP) are acute-phase proteins with diagnostic value in evaluating critically ill pediatric patients with sepsis and detecting sepsis severity. PSP and copeptin had the power to discriminate non-survivors from survivors. APOA5 was less powerful than the other biomarkers in discriminating between survivors and non-survivors.

Биологические Маркеры Сепсиса

“…Аполипопротеин A-V − белок, который у человека кодируется геном APOA5, -копептин и PSP являются белками острой фазы, имеющими диагностическое значение при оценке тяжело больных детей с сепсисом и определении тяжести заболевания. PSP и копептин можно использовать для прогноза выживания при сепсисе [84].…”

Biological markers of sepsis

“…PSP together with apolipoprotein A-V and copeptin are acute-phase proteins that have a diagnostic value in the assessment of seriously ill children with sepsis. PSP and copeptin can be used to predict survival in sepsis [88].…”

Usefulness of pancreatic stone protein measurement to screen and diagnose sepsis in the context of the Surviving Sepsis Campaign recommendations.

“…Searching for clinical studies of PSP and infection or sepsis in PubMed, we identified 1 prospective multicenter study, 29 20 prospective observational studies (Table 3 and 4), 2 meta-analyses, 30,31 2 literature reviews, 32,33 1 economic study, 34 2 technology study, 35,36 1 case report, 37 3 Covid-19 studies, [38][39][40] 1 book chapter, 41 2 point-of-view articles. 42,43 From the PubMed citations, we excluded 8 children studies, [44][45][46][47][48][49][50][51] 3 neonate studies, [52][53][54] 1 post-mortem study, 55 1 study in women for pregnancy-related disease, 56 1 PSP and diabetes study, 57 2 study protocols, 58,59 1 letter, 60 1 editorial, 61 4 comments, [62][63][64][65] and 1 published erratum. 66…”

“…35 Several classical ELISA kits with results obtained within 2 to 3 hours are used and commercialized in China. 46,48,83 In addition, the new Chinese AlphaLISA technology calibrated using an ELISA technic can also deliver results in 5 minutes. 36 PANCREATIC STONE PROTEIN ECONOMIC STUDY A 2021 independent US economic study showed that the use of PSP at a hypothetical price of 52 US$ could save the US healthcare system US$7 billion a year.…”