Yan Zhou, Di Ren, Yanhong Chen, Sha Wen, Yiwen Zhang, Fei Song, Mei Yang, Michael Eisenhut, James O'Rourke, Ying Li, Shuiqing Gui
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Blood samples were sent for blood culture and mNGS when the patients were diagnosed with sepsis. Plasma PSEP, PCT, and IL-6 levels were measured using whole blood specimens that were collected and analyzed after a diagnosis of sepsis. Area under the receiver operating characteristic curve (AUC) was used to evaluate the accuracy of PSEP, PCT, IL-6, and hsCRP for prediction of bacterial DNAaemia detected by mNGS in patients with sepsis.</p><p><strong>Results: </strong>This study included 230 patients with sepsis. The bacterial DNAaemia rate was 53.0% [Gram-positive DNAaemia (GPD), Gram-negative DNAaemia (GND), and fungi DNAaemia rate was 18.2%, 37.8%, and 10.9%, respectively]. Among GND, <i>Klebsiella</i> was the most common, followed by <i>Escherichia coli</i>; meanwhile, the GPD were mainly <i>Enterococcus</i>, and <i>Aspergillus</i> was identified in 5 patients with sepsis. The PSEP median values were significantly higher in GND than in non-GND [GND: 1,291 pg/mL, interquartile range (IQR) 456-3,502 pg/mL; non-GND: 707 pg/mL, IQR 332-2,417 pg/mL; P=0.035]. There was no significant difference in PSEP values between GPD and non-GPD groups, or between fungi DNAaemia and non-fungi DNAaemia groups. Receiver operating characteristics analysis indicated that the best cutoff values for PSEP, PCT, IL-6, and hsCRP were 869 pg/mL, 1.14 ng/mL, 85.5 pg/mL, and hsCRP 96.2 mg/L, respectively. Logistic regression indicated that PSEP, PCT, IL-6, and hsCRP had significant predictive value for GND in patients with sepsis. The levels of PCT and IL-6 were different between patients with GPD and those with non-GPD. Only PCT levels differed significantly between fungal DNAaemia and nonfungal DNAaemia.</p><p><strong>Conclusions: </strong>Bacterial-DNAaemia was detected in half of the patients with sepsis. PSEP, PCT, IL-6, and hsCRP demonstrated significant predictive value for GND, PCT and IL-6 levels demonstrated significant predictive value for GPD. Meanwhile, only PCT demonstrated significant predictive value for fungal DNAaemia.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 2","pages":"991-1001"},"PeriodicalIF":2.1000,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898362/pdf/","citationCount":"0","resultStr":"{\"title\":\"Presepsin, procalcitonin, interleukin-6, and high-sensitivity C-reactive protein for predicting bacterial DNAaemia among patients with sepsis.\",\"authors\":\"Yan Zhou, Di Ren, Yanhong Chen, Sha Wen, Yiwen Zhang, Fei Song, Mei Yang, Michael Eisenhut, James O'Rourke, Ying Li, Shuiqing Gui\",\"doi\":\"10.21037/jtd-24-1714\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Anti-infective therapy against pathogens is the key to treatment of sepsis. Metagenomic next-generation sequencing (mNGS) has higher sensitivity than blood culture. The aim of this study was to use mNGS to identify DNAaemia of pathogens and to assess the diagnostic accuracy of presepsin (PSEP), procalcitonin (PCT), interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hsCRP) in differentiating between bacterial and nonbacterial infections in patients with sepsis.</p><p><strong>Methods: </strong>This retrospective study included patients with sepsis from November 2020 to September 2022 in the Shenzhen Second People's Hospital. Blood samples were sent for blood culture and mNGS when the patients were diagnosed with sepsis. Plasma PSEP, PCT, and IL-6 levels were measured using whole blood specimens that were collected and analyzed after a diagnosis of sepsis. Area under the receiver operating characteristic curve (AUC) was used to evaluate the accuracy of PSEP, PCT, IL-6, and hsCRP for prediction of bacterial DNAaemia detected by mNGS in patients with sepsis.</p><p><strong>Results: </strong>This study included 230 patients with sepsis. The bacterial DNAaemia rate was 53.0% [Gram-positive DNAaemia (GPD), Gram-negative DNAaemia (GND), and fungi DNAaemia rate was 18.2%, 37.8%, and 10.9%, respectively]. Among GND, <i>Klebsiella</i> was the most common, followed by <i>Escherichia coli</i>; meanwhile, the GPD were mainly <i>Enterococcus</i>, and <i>Aspergillus</i> was identified in 5 patients with sepsis. The PSEP median values were significantly higher in GND than in non-GND [GND: 1,291 pg/mL, interquartile range (IQR) 456-3,502 pg/mL; non-GND: 707 pg/mL, IQR 332-2,417 pg/mL; P=0.035]. There was no significant difference in PSEP values between GPD and non-GPD groups, or between fungi DNAaemia and non-fungi DNAaemia groups. Receiver operating characteristics analysis indicated that the best cutoff values for PSEP, PCT, IL-6, and hsCRP were 869 pg/mL, 1.14 ng/mL, 85.5 pg/mL, and hsCRP 96.2 mg/L, respectively. Logistic regression indicated that PSEP, PCT, IL-6, and hsCRP had significant predictive value for GND in patients with sepsis. The levels of PCT and IL-6 were different between patients with GPD and those with non-GPD. Only PCT levels differed significantly between fungal DNAaemia and nonfungal DNAaemia.</p><p><strong>Conclusions: </strong>Bacterial-DNAaemia was detected in half of the patients with sepsis. PSEP, PCT, IL-6, and hsCRP demonstrated significant predictive value for GND, PCT and IL-6 levels demonstrated significant predictive value for GPD. 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引用次数: 0
摘要
背景:针对病原体的抗感染治疗是治疗败血症的关键。与血液培养相比,元基因组新一代测序(mNGS)具有更高的灵敏度。本研究旨在使用 mNGS 鉴定病原体的 DNA 血症,并评估前体素(PSEP)、降钙素原(PCT)、白细胞介素-6(IL-6)和高敏 C 反应蛋白(hsCRP)在区分败血症患者细菌感染和非细菌感染方面的诊断准确性:这项回顾性研究纳入了深圳市第二人民医院 2020 年 11 月至 2022 年 9 月期间的败血症患者。当患者被诊断为败血症时,血液样本会被送去做血培养和 mNGS。血浆 PSEP、PCT 和 IL-6 水平是在脓毒症确诊后采集并分析的全血标本。接受者操作特征曲线下面积(AUC)用于评估 PSEP、PCT、IL-6 和 hsCRP 预测 mNGS 检测到的脓毒症患者细菌 DNAaemia 的准确性:本研究共纳入 230 名败血症患者。细菌 DNA 贫血率为 53.0%[革兰氏阳性 DNA 贫血率(GPD)、革兰氏阴性 DNA 贫血率(GND)和真菌 DNA 贫血率分别为 18.2%、37.8% 和 10.9%]。在革兰氏阴性 DNA 血症(GND)中,克雷伯菌最常见,其次是大肠埃希菌;而革兰氏阴性 DNA 血症(GPD)主要是肠球菌,在 5 名败血症患者中发现了曲霉菌。GND患者的PSEP中位值明显高于非GND患者[GND:1,291 pg/mL,四分位距(IQR)456-3,502 pg/mL;非GND:707 pg/mL,IQR 332-2,417 pg/mL;P=0.035]。GPD组和非GPD组之间、真菌DNAaemia组和非真菌DNAaemia组之间的PSEP值没有明显差异。接收者操作特征分析表明,PSEP、PCT、IL-6 和 hsCRP 的最佳临界值分别为 869 pg/mL、1.14 ng/mL、85.5 pg/mL,以及 hsCRP 96.2 mg/L。逻辑回归表明,PSEP、PCT、IL-6 和 hsCRP 对脓毒症患者的 GND 具有显著的预测价值。PCT和IL-6的水平在GPD患者和非GPD患者之间存在差异。只有PCT水平在真菌DNA血症和非真菌DNA血症之间存在明显差异:结论:半数败血症患者检测到细菌 DNA 血症。PSEP、PCT、IL-6 和 hsCRP 对 GND 有显著的预测价值,PCT 和 IL-6 水平对 GPD 有显著的预测价值。与此同时,只有 PCT 对真菌 DNA 血症有显著的预测价值。
Presepsin, procalcitonin, interleukin-6, and high-sensitivity C-reactive protein for predicting bacterial DNAaemia among patients with sepsis.
Background: Anti-infective therapy against pathogens is the key to treatment of sepsis. Metagenomic next-generation sequencing (mNGS) has higher sensitivity than blood culture. The aim of this study was to use mNGS to identify DNAaemia of pathogens and to assess the diagnostic accuracy of presepsin (PSEP), procalcitonin (PCT), interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hsCRP) in differentiating between bacterial and nonbacterial infections in patients with sepsis.
Methods: This retrospective study included patients with sepsis from November 2020 to September 2022 in the Shenzhen Second People's Hospital. Blood samples were sent for blood culture and mNGS when the patients were diagnosed with sepsis. Plasma PSEP, PCT, and IL-6 levels were measured using whole blood specimens that were collected and analyzed after a diagnosis of sepsis. Area under the receiver operating characteristic curve (AUC) was used to evaluate the accuracy of PSEP, PCT, IL-6, and hsCRP for prediction of bacterial DNAaemia detected by mNGS in patients with sepsis.
Results: This study included 230 patients with sepsis. The bacterial DNAaemia rate was 53.0% [Gram-positive DNAaemia (GPD), Gram-negative DNAaemia (GND), and fungi DNAaemia rate was 18.2%, 37.8%, and 10.9%, respectively]. Among GND, Klebsiella was the most common, followed by Escherichia coli; meanwhile, the GPD were mainly Enterococcus, and Aspergillus was identified in 5 patients with sepsis. The PSEP median values were significantly higher in GND than in non-GND [GND: 1,291 pg/mL, interquartile range (IQR) 456-3,502 pg/mL; non-GND: 707 pg/mL, IQR 332-2,417 pg/mL; P=0.035]. There was no significant difference in PSEP values between GPD and non-GPD groups, or between fungi DNAaemia and non-fungi DNAaemia groups. Receiver operating characteristics analysis indicated that the best cutoff values for PSEP, PCT, IL-6, and hsCRP were 869 pg/mL, 1.14 ng/mL, 85.5 pg/mL, and hsCRP 96.2 mg/L, respectively. Logistic regression indicated that PSEP, PCT, IL-6, and hsCRP had significant predictive value for GND in patients with sepsis. The levels of PCT and IL-6 were different between patients with GPD and those with non-GPD. Only PCT levels differed significantly between fungal DNAaemia and nonfungal DNAaemia.
Conclusions: Bacterial-DNAaemia was detected in half of the patients with sepsis. PSEP, PCT, IL-6, and hsCRP demonstrated significant predictive value for GND, PCT and IL-6 levels demonstrated significant predictive value for GPD. Meanwhile, only PCT demonstrated significant predictive value for fungal DNAaemia.
期刊介绍:
The Journal of Thoracic Disease (JTD, J Thorac Dis, pISSN: 2072-1439; eISSN: 2077-6624) was founded in Dec 2009, and indexed in PubMed in Dec 2011 and Science Citation Index SCI in Feb 2013. It is published quarterly (Dec 2009- Dec 2011), bimonthly (Jan 2012 - Dec 2013), monthly (Jan. 2014-) and openly distributed worldwide. JTD received its impact factor of 2.365 for the year 2016. JTD publishes manuscripts that describe new findings and provide current, practical information on the diagnosis and treatment of conditions related to thoracic disease. All the submission and reviewing are conducted electronically so that rapid review is assured.