Pancreatic stone protein (PSP), C-reactive protein (CRP), and procalcitonin (PCT) are potential biomarkers for early detection of infection and sepsis in critically ill patients.
A poster presentation @ISICEM on Pancreatic Stone Protein (PSP) highlighted how this biomarker plays a role as an early sepsis predictor.
The study aimed to evaluate and compare the effectiveness of these biomarkers in identifying infection and sepsis in patients admitted to ICUs. The study included 274 ICU patients from three hospitals in the UAE who were suspected of having an infection or sepsis. Plasma levels of PSP, CRP, and PCT were measured at admission and again 48 hours later. Patients were categorised into groups based on culture results: culture-negative infection, culture-positive infection, culture-negative sepsis, and culture-positive sepsis.
After the final analysis, 272 patients remained in the study, with 45% having culture-confirmed infections and 38.16% diagnosed with sepsis. The median PSP levels in culture-negative and culture-positive infections were 142 ng/mL and 229 ng/mL, respectively, showing a statistically significant difference. In contrast, CRP levels in these groups were 164.78 mg/L and 191 mg/L, respectively, but the difference was not statistically significant. Similarly, PCT levels in culture-negative and culture-positive infections were 2.16 ng/mL and 2.19 ng/mL, with no significant difference.
Among patients diagnosed with sepsis, PSP levels were 181.5 ng/mL in culture-negative cases and 229 ng/mL in culture-positive cases, but this difference was not significant. CRP levels were significantly higher in culture-positive sepsis cases (208 mg/L) compared to culture-negative cases (132.03 mg/L). However, PCT levels remained statistically insignificant between the two groups.
To evaluate the diagnostic accuracy of these biomarkers, the study analysed their area under the receiver operating characteristic (AUROC) curve at admission. The AUROC values for PSP were 0.58 and 0.53 for detecting infections and sepsis, respectively. CRP had AUROC values of 0.56 and 0.59, while PCT showed values of 0.54 and 0.53, respectively. These results indicate that none of the three biomarkers demonstrated strong diagnostic performance for infection or sepsis in ICU patients.
Regarding treatment outcomes, the study found that infected patients received antibiotics for an average of nine days, while non-infected patients had a shorter antibiotic course of five days.
In conclusion, while PSP levels were higher in culture-positive infections and CRP levels were elevated in culture-positive sepsis, none of the biomarkers provided sufficient diagnostic accuracy to reliably detect infection or sepsis in critically ill patients. This suggests that while these biomarkers may have some utility, they should not be solely relied upon for diagnosing infections in ICU settings.
Source: Poster Presentation and Abstract @ISICEM
Image Credit: ISICEM 2025 and Abionic
