Pentraxin-3 Is a Strong Biomarker of Sepsis Severity Identification and Predictor of 90-Day Mortality in Intensive Care Units via Sepsis 3.0 Definitions

Abstract

Background: Sepsis is the leading cause of mortality in intensive care units (ICUs). However, early diagnosis and prognosis of sepsis and septic shock are still a great challenge. Pentraxin-3 (PTX3) was shown to be associated with the severity and outcome of sepsis and septic shock. This study was carried out to investigate the diagnostic and prognostic value of PTX3 in patients with sepsis and septic shock based on Sepsis 3.0 definitions.

Methods: In this single-center prospective observational study, all patients' serum was collected for biomarker measurements within 24 h after admission. Logistic and Cox regression analyses were used to identify the potential biomarkers of diagnosis, severity stratification, and prediction.

Results: Serum levels of PTX3 were significantly increased on the first day of ICU admission, while septic shock patients had highest PTX3 levels than other groups. A combination between PTX3 and procalcitonin (PCT) could better discriminate sepsis and septic shock, and PTX3 was an independent predictor of mortality in sepsis and septic shock patients.

Conclusion: PTX3 may be a robust biomarker to classify the disease severity and predict the 90-day mortality of sepsis and septic shock based on the latest Sepsis 3.0 definitions.

Keywords: biomarker; intensive care units; pentraxin-3; prognosis; sepsis; septic shock.

Figure 1

Flow chart of the study population. * Healthy controls were not used for analysis.

Figure 2

Pentraxin-3(PTX3) levels and demographics. These panels show the existing differences in serum levels of PTX3 in ICU patients by selected demographics. PTX3 levels were higher in sepsis and septic shock patients (A), in non-survivors with 90-day (B), in patients with sub-SOFA score > 2 (C), and in patients with more failure organs (D). Concentrations of PTX3 were measured by ELISAs. Data are presented as the median and interquartile range (Mann–Whitney U test or Kruskal–Wallis test, respectively). * p < 0.05, ** p < 0.01, *** p < 0.001, Here “ns” means “ not significant”.

Figure 3

Correlations of PTX3 with traditional severity parameters in ICU patients with sepsis and septic shock. The significance of correlations is shown in the upper correlation heatmap.

Figure 4

Receiver-operating characteristic (ROC) curves for diagnosing sepsis (A) and septic shock (B) by pentraxin-3 (PTX3), procalcitonin (PCT), lactate, and platelet count.

Figure 5

Survival analysis for sepsis patients without or with shock. (A) Kaplan–Meier survival curves for patients between high and low levels of pentraxin-3 (PTX3), the dashed lines represent those with PTX3 levels above the cut-off value (11.12 ng/mL). (B) Forest plot of adjusted hazard ratios for septic shock patients relative to sepsis patients without shock with levels of biomarkers below cut-off value by univariate and multivariate Cox regression analysis. Hazard ratios are adjusted for age and gender.

Figure 5

Survival analysis for sepsis patients without or with shock. (A) Kaplan–Meier survival curves for patients between high and low levels of pentraxin-3 (PTX3), the dashed lines represent those with PTX3 levels above the cut-off value (11.12 ng/mL). (B) Forest plot of adjusted hazard ratios for septic shock patients relative to sepsis patients without shock with levels of biomarkers below cut-off value by univariate and multivariate Cox regression analysis. Hazard ratios are adjusted for age and gender.