Role of plasma bactericidal/permeability-increasing protein, group IIA phospholipase A₂, C-reactive protein, and white blood cell count in the early detection of severe sepsis in the emergency department

Abstract

Objectives: To study the diagnostic values of bactericidal/permeability-increasing protein (BPI), group IIA phospholipase A₂ (PLA₂GIIA), white blood cell count (WBC), and C-reactive protein (CRP) in identifying severe sepsis upon admission in an emergency room. Methods: This was a single-centre prospective cohort study involving 525 adult patients admitted to the emergency room with suspected infection. Plasma samples were taken concurrently with the blood cultures. Forty-nine patients with severe sepsis and 476 other patients (58 with no systemic inflammatory response syndrome (SIRS) and no bacterial infection, 63 with bacterial infection but no SIRS, 53 with SIRS but no bacterial infection, and 302 with sepsis but no organ dysfunction) were evaluated. BPI and PLA₂GIIA were measured by time-resolved fluoroimmunoassay, and CRP with an immunoturbidimetric assay. WBC was measured using an automatic cell counter. Results: There was a positive correlation between the plasma levels of PLA₂GIIA and CRP (Pearson's correlation coefficient 0.60, p < 0.001). On logistic regression analysis the odds ratio (OR) (95% confidence limits (95% Cl)) for BPI was 2.66 (1.54–4.60, p = 0.001), for PLA₂GIIA 1.48 (1.20–1.81, p < 0.001), for CRP 1.35 (1.02–1.77, p = 0.036), and for WBC 2.81 (1.48–5.34, p = 0.002). The differences in area under the receiver operator characteristic curve (AUC) between these parameters were not significant. On multivariate logistic regression analysis only PLA₂GIIA could differentiate patients with severe sepsis from others (OR 1.37, 95% Cl 1.05–1.78, p = 0.019). After adjusting for confounders PLA₂GIIA remained a significant independent predictor of severe sepsis. Conclusions: PLA₂GIIA seemed to be superior to CRP, BPI, and WBC in differentiating patients with severe sepsis. BPI gave no additional information in this respect.

Keywords::

• Bactericidal/permeability-increasing protein
• group IIA phospholipase A₂
• severe sepsis

Acknowledgements

We thank research nurses Leena Liljeroos, Liisa Nurmi, and Nina Väänänen, and system analysts Jukka Saukkoriipi and Teemu Möttönen for invaluable assistance during this project. This study was supported by the Satakunta Central Hospital Research Fund and the Turku University Hospital Research Fund.

Declaration of interest: The authors declare no conflicts of interest.