Abstract
Background Sepsis-related acute respiratory distress syndrome (ARDS) has worse clinical outcomes than non-sepsis-related ARDS. Early identification of sepsis-related or non-sepsis-related ARDS is challenging. Presepsin is known to be elevated in sepsis, but little is known about its discriminatory ability and prognostic evaluation in patients with sepsis-related ARDS.Methods This study was a multicenter prospective cohort study of 225 consecutive patients, enrolled based on the Berlin criteria for ARDS between September 2017 and August 2019. The patients were stratified into two groups: sepsis-related ARDS and non-sepsis-related ARDS. Plasma presepsin and serum procalcitonin (PCT) were measured, and the Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were calculated to evaluate disease severity.Results Patients with sepsis-related ARDS had higher presepsin levels at admission than patients with non-sepsis-related ARDS (P<0.001). The area under the receiver operating characteristic (ROC) curve of presepsin (0.81) was significantly greater than that of PCT (0.62) in diagnosing sepsis-related ARDS (P=0.001). Among patients with sepsis-related ARDS, presepsin levels were significantly higher in non-survivors than in survivors (P<0.001). Presepsin was found to be an independent predictor of in-hospital mortality in sepsis-related ARDS. Based on ROC analysis, the addition of presepsin improved discrimination based on SOFA or APACHE II scores from 0.77 to 0.87 or 0.73 to 0.85 (all P<0.05), respectively. The levels of plasma presepsin were positively correlated with disease severity, as determined by the SOFA score in the sepsis-related ARDS group (P<0.001).Conclusions Presepsin is a valuable biomarker for early stratification of sepsis-related ARDS. Higher plasma presepsin levels are associated with increased mortality in sepsis-related ARDS.
Discriminatory Ability and Prognostic Evaluation of Presepsin for Sepsis-Related Acute Respiratory Distress Syndrome
