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CRB-65, CRP and PSP in the ED have an excellent accuracy to rule out early mortality in COVID-19. Combining CRB-65 and either biomarker improved their prognostic accuracy. As reported for sepsis, PSP appears to be a good biomarker to exclude short term risk of death , but not to exclude ICU admission in the context of COVID-19, suggesting different pathophysiological pathways for end-organ damage. Further research is needed to determine the clinical significance of PSP in the context of COVID-19 and its potential role as triage tool.
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Sepsis is a life-threatening organ dysfunction in response to infection. Early recognition and rapid treatment are critical to patient outcomes and cost savings, but sepsis is difficult to diagnose because of its non-specific symptoms. Biomarkers such as pancreatic stone protein (PSP) offer rapid results with greater sensitivity and specificity than standard laboratory tests.
According to the Third International Consensus Definitions for Sepsis and Septic Shock, sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection . A recent study estimated that there were 48.9 million sepsis cases across the globe in 2017, 11 million of which resulted in sepsis-related death, which is substantially greater than the number of worldwide deaths caused by tuberculosis (1.5 million deaths), Human Immunodeficiency Virus (HIV) (0.68 million deaths) and Malaria (0.63 million deaths) in 2020 . The Centers for Disease Control and Prevention (CDC) estimate that 1.7 million adults in the United States develop sepsis each year [3, 4]. Sepsis is a common cause of morbidity and mortality in US hospitals, and it is a significant economic burden; it was the most expensive condition treated in US hospitals in 2013, costing the US nearly $24 billion [3, 5,6,7]. A 2020 analysis of Medicare claims found a 40% increase in sepsis-related inpatient hospital admissions between 2012 and 2018, and associated costs have risen from $17.8 billion to $22.4 billion .
The national cost of sepsis is difficult to estimate due to uncertainty around the incidence of sepsis in the United States, which varies depending on the criteria and data sources used to identify sepsis. Claims analyses may identify septic patients through explicit ICD-10 codes and may also include codes for organ dysfunction and infection that imply sepsis [3, 7]. Clinical data analyses may use different clinical criteria to identify sepsis including Sequential Organ Failure Assessment (SOFA) score, quick SOFA score, and Systemic Inflammatory Response Syndrome criteria [3, 38, 39].
The RESP component is derived from the more complex SOFA score, which is used to track the status of a patient in the ICU and to determine the extent of organ function or rate of failure. However, this score is based on six different sub-scores making it complex to obtain and inaccessible outside of the ICU.
PSP is characterised by its diagnostic accuracy in predicting sepsis and/or multiple organ dysfunction in various types of critically ill patients2. As of today more than 20 publications demonstrate that PSP correlates well with several sub-scores of SOFA. Preliminary data from the first European wave of SARS-CoV-2 infections shows a strong link between PSP concentration and the severity of these patients.
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Spirorchiid trematodes are blood flukes that have been implicated in worldwide mass stranding and mortality events of sea turtles. The disease caused by this trematode infection, spirorchiidiasis, results in injury and inflammation to larger arteries, the central nervous system, endocrine organs, and the gastrointestinal tract. Incidental infections may be common and may not cause sea turtle strandings or death. Additional research is needed to better understand species-specific and geographic-specific patterns of spirorchiid trematode infection and host-health consequences in sea turtles. Distinguishing sprirorchiidiasis from PSP may be needed in some contexts.
Preliminary observations suggest that recovery trajectories of sea turtles with PSP may be rapid (hours) relative to spirorchiidiasis rehabilitation (weeks). Short periods in captivity in a resting state, with regurgitation of potentially poisonous stomach contents of gelatinous organisms, may aid in PSP rehabilitation. More research is warranted on this topic. 1e1e36bf2d