New article: Calprotectin as a sepsis marker and mortality predictor

08. Jan 2020 | 7 min read

New article: Calprotectin as a sepsis marker and mortality predictor

“Calprotectin is superior to procalcitonin as a sepsis marker and predictor of 30-day mortality in intensive care patients”

The newly published article Calprotectin is superior to procalcitonin as a sepsis marker and predictor of 30-day mortality in intensive care patients in the Scandinavian Journal of Clinical and Laboratory Investigation, is based on a prospective observational study in an ICU unit at Östersund hospital in Sweden. A total of 271 patients are included in the study.

The aim of the study has been to compare the performance of calprotectin as a biomarker for sepsis and predictor of mortality in ICU patients with the more widely used biomarker procalcitonin (PCT). You can read the full article here. This article is based on the same study that was presented at the International Sepsis Forum in Bangkok in 2018.

In this study plasma calprotectin has been measured with a particle-enhanced turbidimetric assay (PETIA) methodology. The study has used calprotectin reagents from Gentian and a Mindray BS380 chemistry analyser. Aleksandra Mandic Havelka, Director of Clinical Affairs in Gentian is one of the co-authors of this article”.

Background for the study

Sepsis is the most frequent cause of admission to intensive care units (ICUs), and the most common cause of death in ICUs [1]. Since sepsis is associated with non-specific symptoms it is difficult to diagnose [2]. A rapid and correct diagnosis and initiation of therapy is therefore very important for improving patient outcomes, as any delay in treatment will increase mortality [3].

Biomarkers have an important role in both the detection of sepsis and the estimation of the severity of the disease. A widely used biomarker is C-reactive protein (CRP), but since CRP is mainly an inflammation marker, the specificity in sepsis has been challenged [4]. Procalcitonin (PCT) is together with CRP the most widely used sepsis biomarker today. PCT has been proposed as a more specific [5] and better prognostic [6] marker than CRP, but this has also been questioned [7].

calprotectin versus procalcitonin study

 

Calprotectin and PETIA

Determination of serum calprotectin has been proposed as a valuable biomarker for diagnosis of sepsis [8-11]. Early release of calprotectin from activated neutrophils along with short test turn-around-times with a PETIA assay suggest that calprotectin can become a useful sepsis biomarker.

PETIA is a technology that can be applied on routine chemistry analysers available at most clinical chemistry laboratories. In comparison with enzyme-linked immunosorbent assay (ELISA), PETIA is designed for measuring single samples, and thus, significantly shortens the time from test to results. This is especially important here, as sepsis is an acute condition that requires rapid test results.

Results

The levels of plasma calprotectin were significantly higher in patients with sepsis when compared with patients with trauma and other non-septic conditions. The calprotectin concentrations at admission were also higher in non-survivors than in survivors at day 30. Levels of PCT in plasma did not differ significantly between septic and non-septic patients nor in survivors compared with non-survivors.

In our study, calprotectin was superior to PCT for distinguishing between ICU patients with sepsis and non-sepsis. Calprotectin had also higher predictive ability regarding 30-day mortality.

Read the full article here.

Plasma Calprotectin Immunoassay

Are you interested to learn more about calprotectin in the clinical setting and also to learn more about Gentian's plasma calprotectin assay? Get in touch with our Product Manager for Calprotectin through marketing@gentian.com.

Our use the link below to read more: 

Learn more about our Plasma Calprotectin Immunoassay

 

About the article

The article is published in the Scandinavian Journal of Clinical and Laboratory

Investigation December 14th 2019*.

Authors:

Anders Larsson, Department of Medical Sciences, Clinical Chemistry, University Hospital, Uppsala, Sweden

Jonas Tydén, Department of Surgical and Perioperative Sciences, Anaesthesiology and Critical Care Medicine (Ostersund), Umeå University, Umeå, Sweden

Joakim Johansson, Department of Surgical and Perioperative Sciences, Anaesthesiology and Critical Care Medicine (Ostersund), Umeå University, Umeå, Sweden

Miklos Lipcsey, Department of Surgical Sciences, Anaesthesiology and Intensive care, Hedenstierna laboratory, Uppsala University, Uppsala, Sweden;

Maria Bergquist, Department of Surgical Sciences, Anaesthesiology and Intensive care, Hedenstierna laboratory, Uppsala University, Uppsala, Sweden;

Kim Kultima, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

Aleksandra Mandic-Havelka, Gentian Diagnostics AB and Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

 

References

[1] GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1459–1544.

[2] Kaukonen KM, Bailey M, Pilcher D, et al. Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med. 2015;372(17):1629–1638.

[3] Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical Care Med. 2006;34(6):1589–1596.

[4] Yeh CF, Wu CC, Liu SH, et al. Comparison of the accuracy of neutrophil CD64, procalcitonin, and C-reactive protein for sepsis identification: a systematic review and meta-analysis. Ann Intens Care. 2019;9:5.

[5] Wacker C, Prkno A, Brunkhorst FM, et al. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13(5):426–435.

[6] Arora S, Singh P, Singh PM, et al. Procalcitonin levels in survivors and nonsurvivors of sepsis: systematic review and meta-analysis. Shock. 2015;43(3):212–221.

[7] Tang BM, Eslick GD, Craig JC, et al. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect Dis. 2007;7(3):210–217.

[8] Terrin G, Passariello A, Manguso F, et al. Serum calprotectin: an antimicrobial peptide as a new marker for the diagnosis of sepsis in very low birth weight newborns. Clin Dev Immunol. 2011;2011:1.

[9] Pepper RJ, Hamour S, Chavele KM, et al. Leukocyte and serum S100A8/S100A9 expression reflects disease activity in ANCA-associated vasculitis and glomerulonephritis. Kidney Int. 2013;83(6):1150–1158.

[10] Gao S, Yang Y, Fu Y, et al. Diagnostic and prognostic value of myeloid-related protein complex 8/14 for sepsis. Am J Emerg Med. 2015;33(9):1278–1282.

[11] Jonsson N, Nilsen T, Gille-Johnson P, et al. Calprotectin as an early biomarker of bacterial infections in critically ill patients: an exploratory cohort assessment. Crit Care Resusc. 2017;19(3):205–213.

 

* The authors have no financial conflicts of interest

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