Development of the new biomarker in the early diagnosis of elderly people severe bacterial infection in the emergency department

2018 Fiscal Year Final Research Report

• Project/Area Number: 16K20405
• Research Category: Grant-in-Aid for Young Scientists (B)
• Allocation Type: Multi-year Fund
• Research Field: Emergency medicine
• Research Institution: Osaka Medical College
• Principal Investigator: Imai Yoshiro 大阪医科大学, 医学部, 助教 (60734415)
• Research Collaborator: Takasu Akira
• Project Period (FY): 2016-04-01 – 2019-03-31
• Keywords: プレセプシン / 救急外来 / 高齢者 / 菌血症

Outline of Final Research Achievements

This prospective study was conducted in the emergency department (ED) of a teaching hospital. Patients aged 70 years old or over and who fulfilled the systemic inflammatory response syndrome criteria were included in this study. Blood sampling to evaluate CRP, PCT, presepsin plasma levels; two sets of blood sampling for bacterial cultures; and evaluations of the Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE II) scores were performed upon arrival at the ED. The results were compared between patients with bacteremia and those without bacteremia.
The presepsin value was significantly higher in the bacteremia group than in the non-bacteremia group. The PCT and CRP did not significantly differ between the groups. Multivariate analysis showed that presepsin was independently associated with bacteremia. Similar to CRP and PCT, presepsin was a useful biomarker to detect bacteremia in elderly patients admitted to the ED.

Free Research Field

救急医学

Academic Significance and Societal Importance of the Research Achievements

高齢者は若年者に比べて免疫力が低下しており、一度菌血症を併発すると重篤化しやすい。また高齢者は訴えが不明瞭で身体所見に乏しく、重篤感が認められないことが多く菌血症は見逃されやすい。そこで救急外来を受診する感染症疑いの高齢者でプレセプシンを測定して、既存の感染症マーカーと菌血症の判別を行ったところ、プレセプシンの有用性を認めた。今日急速に高齢者社会が進行しており、高齢者の救急搬送数も増加している中、社会的意義のある研究成果と考える。