Role of Presepsin (sCD14-ST) and the CURB65 scoring system in predicting severity and outcome of community-acquired pneumonia in an emergency department.

Background: CD14 is one of the leukocyte differentiation antigens, and is present in macrophages, monocytes, granulocytes and their cell membranes. Presepsin, namely soluble CD14-subtype (sCD14-ST) is produced by circulating plasma proteases activating cleavage of soluble CD14 (sCD14). The aim of this study is to investigate the role of Presepsin and the CURB65 scoring system in the evaluation of severity and outcome of CAP in an ED.

Methods: A prospective, observational study was performed in an ED of an university teaching hospital from November 2011 to October 2012. A total of 359 patients with CAP and 214 patients with severe CAP (SCAP) were consecutively enrolled. Plasma Presepsin, lactate, serum PCT levels and leukocyte counts were measured and CURB65 score were calculated at admission enrollment.

Results: Plasma Presepsin levels were significantly higher in SCAP patients than in CAP patients (P < 0.0001), increasing correspondingly with the enhancement of CURB65 score. Patients with ARDS or DIC had obviously higher plasma Presepsin levels than those without ARDS or DIC (all P < 0.0001), and plasma Presepsin levels were significantly higher in non-survivors than in survivors at 28-day follow-up. In logistic regression analysis, CURB65 score was the independent predictor of ARDS, and Presepsin was the independent predictor of DIC, and Presepsin and CURB65 score were both the independent predictors of 28-day mortality. The AUCs showed Presepsin in combination with CURB65 score in predicting ARDS, SCAP and 28-day mortality was superior to Presepsin or CURB65 score alone ( all P < 0.01), Presepsin was better than CURB65 score and leukocyte in predicting DIC ( P < 0.01).

Conclusions: Presepsin is a valuable biomarker in predicting severity and outcome in CAP patients in the ED and Presepsin in combination with CURB65 score significantly enhanced the predictive accuracy.