Skip to main content

Advertisement

Log in

Diagnostic value of soluble CD14 subtype (sCD14-ST) presepsin for the postmortem diagnosis of sepsis-related fatalities

  • Original Article
  • Published:
International Journal of Legal Medicine Aims and scope Submit manuscript

Abstract

The first aim of this study was to assess the diagnostic performance of presepsin (sCD14-ST) in postmortem serum from femoral blood compared to procalcitonin (PCT) to detect sepsis-related fatalities. The second aim was to compare sCD14-ST levels found in postmortem serum to the values in pericardial fluid to investigate the usefulness of the latter as an alternative biological fluid. Two study groups were formed, a sepsis-related fatalities group and a control group. Radiology (unenhanced CT scans and postmortem angiographies), autopsies, histology, neuropathology, and toxicology as well as other postmortem biochemistry investigations were performed in all cases. Microbiological investigations on right cardiac blood were carried out exclusively in septic cases. The results of this study indicated that postmortem serum PCT and sCD14-ST levels, individually considered, allowed septic cases to be identified. Even though increases in both PCT and sCD14-ST concentrations were observed in the control cases, coherent PCT and sCD14-ST results in cases with suspected sepsis allowed the diagnosis to be confirmed. Conversely, no relevant correlation was identified between postmortem serum and pericardial fluid sCD14-ST levels in either the septic or control groups.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Gaïni A, Koldkjaer OG, Møller HJ, Pedersen C, Pedersen SS (2007) Comparison of high-mobility group-box 1 protein, lipopolysaccharide-binding protein and procalcitonin in severe community-acquired infections and bacteraemia: A prospective study. Crit Care 11(4):R76. doi:10.1186/cc5967

    Article  PubMed  Google Scholar 

  2. Schrag B, Iglesias K, Mangin P, Palmiere C (2012) Procalcitonin and C-reactive protein in pericardial fluid for postmortem diagnosis of sepsis. Int J Leg Med 126(4):567–72

    Article  Google Scholar 

  3. Porcel JM, Vives M, Cao G, Bielsa S, Ruiz-González A, Martínez-Iribarren A, Esquerda A (2009) Biomarkers of infection for the differential diagnosis of pleural effusions. Eur Respir J 34(6):1383–9

    Article  PubMed  CAS  Google Scholar 

  4. Endo S, Suzuki Y, Takahashi G, Shozushima T, Ishikura H, Murai A, Nishida T, Irie Y, Miura M, Iguchi H, Fukui Y, Tanaka K, Nojima T, Okamura Y (2012) Usefulness of presepsin in the diagnosis of sepsis in a multicenter prospective study. J Infect Chemother. doi:10.1007/s10156-012-0435-2

  5. Palmiere C, Mangin P (2012) Postmortem chemistry update part II. Int J Leg Med 126(2):199–215

    Article  Google Scholar 

  6. Schrag B, Roux-Lombard P, Schneiter D, Vaucher P, Mangin P, Palmiere C (2012) Evaluation of C-reactive protein, procalcitonin, tumor necrosis factor alpha, interleukin-6, and interleukin-8 as diagnostic parameters in sepsis-related fatalities. Int J Legal Med 126(4):505–12

    Article  PubMed  Google Scholar 

  7. Herrmann W, Ecker D, Quast S, Klieden M, Rose S, Marzi I (2000) Comparison of procalcitonin, sCD14 and interleukin-6 values in septic patients. Clin Chem Lab Med 38(1):41–6

    Article  PubMed  CAS  Google Scholar 

  8. Eberhard OK, Haubitz M, Brunkhorst FM, Kliem V, Koch KM, Brunkhorst R (1997) Usefulness of procalcitonin for differentiation between activity of systemic autoimmune disease (systemic lupus erythematosus/systemic antineutrophil cytoplasmic antibody-associated vasculitis) and invasive bacterial infection. Arthritis Rheum 40(7):1250–6

    PubMed  CAS  Google Scholar 

  9. Lindahl B, Toss H, Siegbahn A, Venge P, Wallentin L (2000) Markers of myocardial damage and inflammation in relation to long-term mortality in unstable coronary artery disease. FRISC Study Group. Fragmin during instability in coronary artery disease. N Engl J Med 343(16):1139–47

    Article  PubMed  CAS  Google Scholar 

  10. Reinhart K, Meisner M, Brinkhorst FM (2006) Markers for sepsis diagnosis: What is useful? Crit Care Clin 22(6):503–19

    Article  PubMed  CAS  Google Scholar 

  11. Tong HS, Liu YS, Wen Q, Tang YQ, Yuan FF, Su L (2012) Serum procalcitonin predicting mortality in exertional heatstroke. Emerg Med J 29(2):113–7

    Article  PubMed  Google Scholar 

  12. Hausfater P, Hurtado M, Pease S, Juillien G, Lvovschi VE, Salehabadi S, Lidove O, Wollf M, Bernard M, Chollet-Martin S, Riou B (2008) Is procalcitonine a marker of critical illness in heatstroke? Intensive Care Med 34(8):1377–83

    Article  PubMed  CAS  Google Scholar 

  13. Nylén ES, Al Arifi A, Becker KL, Snider RH Jr, Alzeer A (1997) Effect of classic heatstroke on serum procalcitonin. Crit Care Med 25(8):1362–5

    Article  PubMed  Google Scholar 

  14. Balci C, Sivaci R, Akbulut G, Karabekir HS (2009) Procalcitonin levels as an early marker in patients with multiple trauma under intensive care. J Int Med Res 37(6):1709–17

    Article  PubMed  CAS  Google Scholar 

  15. Maier M, Wutzler S, Lehnert M, Szermutzky M, Wyen H, Bingold T, Henrich D, Walcher F, Marzi I (2009) Serum procalcitonin levels in patients with multiple injuries including visceral trauma. J Trauma 66(1):243–9

    Article  PubMed  CAS  Google Scholar 

  16. Mussap M, Degrandi R, Cataldi L, Fanos V, Plebani M (2007) Biochemical markers for the early assessment of neonatal sepsis: The role of procalcitonin. J Chemother 19(Suppl 2):35–8

    PubMed  Google Scholar 

  17. Mussap M, Noto A, Fravega M, Fanos V (2011) Soluble CD14 subtype presepsin (sCD14-ST) and lipopolysaccharide binding protein (LBP) in neonatal sepsis: New clinical and analytical perspectives for two old biomarkers. J Matern Fetal Neonatal Med 24(Suppl 2):12–4

    Article  PubMed  Google Scholar 

  18. Bas S, Gauthier BR, Spenato U, Stingelin S, Gabay C (2004) CD14 is an acute-phase protein. J Immunol 172(7):4470–9

    PubMed  CAS  Google Scholar 

  19. Yaegashi Y, Shirakawa K, Sato N, Suzuki Y, Kojika M, Imai S, Takahashi G, Miyata M, Furusako S, Endo S (2005) Evaluation of a newly identified soluble CD14 subtype as a marker for sepsis. J Infect Chemother 11(5):234–8

    Article  PubMed  CAS  Google Scholar 

  20. Obata K, Segawa O, Yakabe M, Ishida Y, Kuroita T, Ikeda K, Kawakami B, Kawamura Y, Yohda M, Matsunaga T, Tajima H (2001) Development of a novel method for operating magnetic particles, Magtration Technology, and its use for automating nucleic acid purification. J Biosci Bioeng 91(5):500–3

    PubMed  CAS  Google Scholar 

  21. Okamura Y, Yokoi H (2011) Development of a point-of-care assay system for measurement of presepsin (sCD14-ST). Clin Chim Acta 412(23–24):2157–61

    Article  PubMed  CAS  Google Scholar 

  22. NCCLS. Protocols for determination of limits of detection and limits of quantitation; approved guideline. NCCLS document 2004 EP17-A [ISBN 1-56238-551-8]. Nccls, 940 West Valley Road, Suite 1400, Wayne, Pennsylvania 19087–1898 USA, 2004.

  23. Pavnik-Arnol M, Hojker S, Derganc M (2007) Lypopolysaccharide-binding protein, lipopolysaccharide, and soluble CD14 in sepsis of critically ill neonates and children. Intensive Care Med 33(6):1025–32

    Article  Google Scholar 

  24. Chalupa P, Beran O, Herwald H, Kaspříková N, Holub M (2011) Evaluation of potential biomarkers for the discrimination of bacterial and viral infections. Infection 39(5):411–7

    Article  PubMed  CAS  Google Scholar 

  25. Tsokos M (2007) Postmortem diagnosis of sepsis. Forensic Sci Int 165(2–3):155–64

    Article  PubMed  Google Scholar 

  26. Tsokos M, Reichelt U, Nierhaus A, Püschel K (2001) Serum procalcitonin (PCT): A valuable biochemical parameter for the postmortem diagnosis of sepsis. Int J Legal Med 114(4–5):237–43

    Article  PubMed  CAS  Google Scholar 

  27. Tsokos M, Reichelt U, Jung R, Nierhaus A, Püschel K (2001) Interleukin-6 and C-reactive protein serum levels in sepsis-related fatalities during the early postmortem period. Forensic Sci Int 119(1):47–56

    Article  PubMed  CAS  Google Scholar 

  28. Tsokos M, Fehlauer F, Püschel K (2000) Immunohistochemical expression of E-selectin in sepsis-induced lung injury. Int J Legal Med 113(6):338–42

    Article  PubMed  CAS  Google Scholar 

  29. Tsokos M, Fehlauer F (2001) Postmortem markers of sepsis: An immunohistochemical study using VLA-4 (CD49d/CD29) and ICAM-1 (CD54) for the detection of sepsis-induced lung injury. Int J Legal Med 114:291–94

    Article  PubMed  CAS  Google Scholar 

  30. Reichelt U, Jung R, Nierhaus A, Tsokos M (2005) Serial monitoring of interleukin-1β, soluble interleukin-2 receptor and lipopolysaccharide binding protein levels after death. A comparative evaluation of potential postmortem markers of sepsis. Int J Legal Med 119(2):80–87

    Article  PubMed  Google Scholar 

  31. Wright SD, Ramos RA, Tobias PS, Ulevitch RJ, Mathison JC (1990) CD14, a receptor for complexes of lipopolysaccharide (LPS) and LPS binding protein. Science 249(4975):1431–3

    Article  PubMed  CAS  Google Scholar 

  32. Krüger C, Schütt C, Obertacke U, Joka T, Müller FE, Knöller J, Köller M, König W, Schönfeld W (1991) Serum CD14 levels in polytraumatized and severely burned patients. Clin Exp Immunol 85(2):297–301

    Article  PubMed  Google Scholar 

  33. Jabara HH, Vercelli D (1994) Engagement of CD14 on monocytes inhibits the synthesis of human Igs, including IgE. J Immunol 153(3):972–8

    PubMed  CAS  Google Scholar 

  34. Bussolati B, David S, Cambi V, Tobias PS, Camussi G (2002) Urinary soluble CD14 mediates human proximal tubular epithelial cell injury induced by LPS. Int J Mol Med 10(4):441–9

    PubMed  CAS  Google Scholar 

  35. Berner R, Fürll B, Stelter F, Dröse J, Müller HP, Schütt C (2002) Elevated levels of lipopolysaccharide-binding protein and soluble CD14 in plasma in neonatal early-onset sepsis. Clin Diagn Lab Immunol 9(2):440–5

    PubMed  CAS  Google Scholar 

  36. Aalto H, Takala A, Kautiainen H, Siitonen S, Repo H (2007) Monocyte CD14 and soluble CD14 in predicting mortality of patients with severe community acquired infection. Scand J Infect Dis 39(6–7):596–603

    Article  PubMed  CAS  Google Scholar 

  37. Takeshita S, Nakatani K, Tsujimoto H, Kawamura Y, Kawase H, Sekine I (2000) Increased levels of circulating soluble CD14 in Kawasaki disease. Clin Exp Immunol 119(2):376–81

    Article  PubMed  CAS  Google Scholar 

  38. Wüthrich B, Kägi MK, Joller-Jemelka H (1992) Soluble CD14 but not interleukin-6 is a new marker for clinical activity in atopic dermatitis. Arch Dermatol Res 284(6):339–42

    Article  PubMed  Google Scholar 

  39. Oesterreicher C, Pfeffel F, Petermann D, Müller C (1995) Increased in vitro production and serum levels of the soluble lipopolysaccharide receptor sCD14 in liver disease. J Hepatol 23(4):396–402

    Article  PubMed  CAS  Google Scholar 

  40. Horneff G, Sack U, Kalden JR, Emmrich F, Burmester GR (1993) Reduction of monocyte-macrophage activation markers upon anti-CD4 treatment. Decreased levels of IL-1, IL-6, neopterin and soluble CD14 in patients with rheumatoid arthritis. Clin Exp Immunol 91(2):207–13

    Article  PubMed  CAS  Google Scholar 

  41. Yu S, Nakashima N, Xu BH, Matsuda T, Izumihara A, Sunahara N, Nakamura T, Tsukano M, Matsuyama T (1998) Pathological significance of elevated soluble CD14 production in rheumatoid arthritis: In the presence of soluble CD14, lipopolysaccharides at low concentrations activate RA synovial fibroblasts. Rheumatol Int 17(6):237–43

    Article  PubMed  CAS  Google Scholar 

  42. Egerer K, Feist E, Rohr U, Pruss A, Burmester GR, Dörner T (2000) Increased serum soluble CD14, ICAM-1 and E-selectin correlate with disease activity and prognosis in systemic lupus erythematosus. Lupus 9(8):614–21

    Article  PubMed  CAS  Google Scholar 

  43. Nockher WA, Wigand R, Schoeppe W, Scherberich JE (1994) Elevated levels of soluble CD14 in serum of patients with systemic lupus erythematosus. Clin Exp Immunol 96(1):15–9

    Article  PubMed  CAS  Google Scholar 

  44. Gebhard F, Rösch M, Helm M, Strecker W, Buttenschön K, Kinzl L, Bock KH, Brückner UB (1997) Is the activity of soluble CD14 enhanced following major trauma? Arch Surg 132(10):1116–20

    Article  PubMed  CAS  Google Scholar 

  45. Carrillo EH, Gordon L, Goode E, Davis E, Polk HC Jr (2001) Early elevation of soluble CD14 may help identify trauma patients at high risk for infection. J Trauma 50(5):810–6

    Article  PubMed  CAS  Google Scholar 

  46. Landmann R, Zimmerli W, Sansano S, Link S, Hahn A, Glauser MP, Calandra T (1995) Increased circulating soluble CD14 is associated with high mortality in gram-negative septic shock. J Infect Dis 171(3):639–44

    Article  PubMed  CAS  Google Scholar 

  47. Landmann R, Reber AM, Sansano S, Zimmerli W (1996) Function of soluble CD14 in serum from patients with septic shock. J Infect Dis 173(3):661–8

    Article  PubMed  CAS  Google Scholar 

  48. Blanco A, Solis G, Arranz E, Coto GD, Ramos A, Telleria J (1996) Serum levels of CD14 in neonatal sepsis by Gram-positive and Gram-negative bacteria. Acta Paediatr 85(6):728–32

    Article  PubMed  CAS  Google Scholar 

  49. Kitchens RL, Thompson PA (2003) Impact of sepsis-induced changes in plasma on LPS interactions with monocytes and plasma lipoproteins: Roles of soluble CD14, LBP, and acute phase lipoproteins. J Endotoxin Res 9(2):113–8

    PubMed  CAS  Google Scholar 

  50. Shozushima T, Takahashi G, Matsumoto N, Kojika M, Okamura Y, Endo S (2011) Usefulness of presepsin (sCD14-ST) measurements as a marker for the diagnosis and severity of sepsis that satisfied diagnostic criteria of systemic inflammatory response syndrome. J Infect Chemother 17(6):764–9

    Article  PubMed  CAS  Google Scholar 

  51. Maeda H, Zhu BL, Bessho Y, Ishikawa T, Quan L, Michiue T, Zhao D, Li DR, Komatsu A (2008) Postmortem serum nitrogen compounds and C-reactive protein levels with special regard to investigation of fatal hyperthermia. Forensic Sci Med Pathol 4(3):175–80

    Article  PubMed  CAS  Google Scholar 

Download references

Conflicts of interest

The authors have no conflict of interest to declare. GEPA S.r.l. had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. No financial support was received from GEPA S.r.l. for the preparation of this manuscript, the material used for the analyses, the laboratory equipment, or the laboratory personnel involved in this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Cristian Palmiere.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Palmiere, C., Mussap, M., Bardy, D. et al. Diagnostic value of soluble CD14 subtype (sCD14-ST) presepsin for the postmortem diagnosis of sepsis-related fatalities. Int J Legal Med 127, 799–808 (2013). https://doi.org/10.1007/s00414-012-0804-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00414-012-0804-5

Keywords

Navigation