Pancreatic Stone Protein as Sepsis Biomarker in Patients Requiring Mechanical Circulatory Support: A Pilot Observational Study

Objectives: To demonstrate for the first time the performance of the novel biomarker pancreatic stone protein (PSP) in predicting the occurrence of sepsis in cardiogenic shock patients requiring mechanical circulatory support. Many patients with cardiogenic shock develop sepsis and the timely identification and treatment of sepsis remains a key factor to improve outcome and avoid unnecessary antibiotics treatment. Design: Observational study recording PSP values for 5 days or until intensive care unit discharge (whichever came first) to analyze its kinetic and evaluate a potential correlation with sepsis development. Setting: Cardiac intensive care unit. Participants: 32 adult patients with cardiogenic shock requiring mechanical circulatory support, 28% women with a median age of 68 years (range, 60-72 years). Interventions: None. Measurements and Main Results: The main causes of cardiogenic shock were postcardiotomy (50%) and acute myocardial infarction (25%). Patients were supported with and intra-aortic balloon pump (62.5%), Impella (6.3%), or venoarterial extracorporeal membrane oxygenation (3.1%); 28% of patients had more than 1 support device. Forty percent of patients developed sepsis during their intensive care unit stay. The overall median peak PSP reached was 389.5 ng/mL (interquartile range, 222-601 ng/mL), with a peak on day 2. The peak was higher in patients who developed sepsis (601 ng/mL [interquartile range, 556-601 ng/mL] in patients with sepsis v 257 ng/mL [interquartile range, 207-576 ng/mL] in patients without ). In these patients also daily PSP values from day 2 to 5 were higher. Conclusions: Patients supported with mechanical circulatory support who develop sepsis present with significantly higher PSP values than those who do not develop sepsis. PSP values are generally high in this population, even in patients not developing sepsis.