Pancreatic Stone Protein a Potential Predictor of Sepsis Outcome

Alice Goodman

September 20, 2010

September 20, 2010 (Boston, Massachusetts) — Serum levels of pancreatic stone protein (PSP) reflect the clinical severity of sepsis and predict outcomes in patients with severe sepsis and septic shock admitted to the intensive care unit (ICU), according to the results of a prospective study reported here at the 50th Interscience Conference on Antimicrobial Agents and Chemotherapy.

"This marker may be useful to stratify patients with sepsis and septic shock and to guide therapy in the first 48 hours after admission to the ICU. Some patients will need more aggressive therapy, or if comorbidities exist in the presence of elevated PSP, perhaps therapy should be stopped," said Frederick DeLodder, MSN, from the Centre Hospitalier Universitaire Valdois in Lausanne, Switzerland. "Serum PSP level might be useful during the first 24 hours of admission to identify patients at risk for death," he added.

Severe sepsis is a leading cause of death in ICU patients and poses a major challenge to healthcare workers. Reliable and early diagnostic tools could improve risk stratification, optimize treatment for these severely ill patients, and cut down on the unnecessary use of antibiotics, Mr. DeLodder explained.

The study examined 108 patients over a 24-month period. Blood levels of PSP, other cytokines, and procalcitonin (another acute-phase protein) were measured at admission, on day 3, on day 7, and weekly thereafter until discharge from the ICU or death.

Among all hospitalized patients, 33 developed severe sepsis and 75 developed septic shock. Death occurred in 2 (6%) patients with severe sepsis and in 17 (25%) with septic shock.

PSP levels were higher in all patients with sepsis and septic shock than in healthy people. Levels rising up to 2000 ng/mL correlated with severity of sepsis.

At admission, PSP, interleukin-8, and procalcitonin serum levels were significantly higher in people with septic shock than in those with sepsis (P = .002, P = .001, and P = .01, respectively, for all 3 markers). Looking at outcomes, PSP was significantly higher in patients who died than in survivors (P = .007), whereas procalcitonin was not.

"At entry to the ICU, the area under the ROC curve was higher for PSP than for other acute-phase proteins or cytokines. The wide range of PSP serum levels may explain its much better discriminative value compared with procalcitonin," Mr. DeLodder stated.

Preliminary evidence suggests that high PSP values might correlate with specific microorganisms, but more study is needed, he said.

Commenting on the study and the potential utility of PSP as a biomarker of sepsis and septic shock, Richard Drew, PharmD, from Duke University in Chapel Hill, North Carolina, said that biomarkers, such as procalcitonin and C-reactive protein, represent an exciting concept.

"In the context of this study, PSP looks promising for the diagnosis and prognosis [of patients with sepsis and septic shock]. The more support tools we have, the better we manage patients," Dr. Drew stated.

Mr. DeLodder and Dr. Drew have disclosed no relevant financial relationships.

50th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC): Abstract L1-1018. Presented September 13, 2010.


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