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Early change in proenkephalin levels from day 1 to day 3 predicts 7-day mortality in septic critically ill patients: A single-center cohort study from Indonesia

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Alvin Arif, Speaker at Infection Conferences
Alvin Arif
Andalas University, Indonesia
Title : Early change in proenkephalin levels from day 1 to day 3 predicts 7-day mortality in septic critically ill patients: A single-center cohort study from Indonesia

Abstract:

Background: Single-point biomarkers may not adequately reflect disease progression in sepsis. Serial monitoring of biomarkers may improve early risk stratification. Proenkephalin (PENK), a novel biomarker associated with renal dysfunction and organ failure, may provide prognostic value when measured dynamically.

Objective: To evaluate the association between early changes in proenkephalin levels from Day 1 to Day 3 and 7-day mortality in septic critically ill patients.

Methods: We conducted a retrospective observational cohort study involving adult septic patients admitted to the intensive care unit of a tertiary referral hospital in Indonesia. Patients with complete PENK measurements on Day 1 and Day 3 were included. Delta PENK was defined as the change in PENK concentration between Day 1 and Day 3. The primary outcome was all-cause 7-day mortality. Survivors and non-survivors were compared using Mann–Whitney U test. Predictive performance was assessed using receiver operating characteristic (ROC) curve analysis.

Results: A total of 84 patients had complete serial PENK measurements. Of these, 39 patients died within 7 days. Survivors demonstrated decreasing PENK levels from Day 1 to Day 3 (74.2 to 66.8; delta -7.4), whereas non-survivors showed marked increases (105.9 to 141.6; delta +35.7). The difference in delta PENK between groups was statistically significant (p = 0.002). ROC analysis showed good discriminative ability of delta PENK for predicting 7-day mortality. AUC=0.781

Conclusion: Early rise in proenkephalin levels from Day 1 to Day 3 was significantly associated with 7-day mortality and outperformed single admission measurements. Serial PENK monitoring may serve as a useful tool for early prognostic stratification in septic critically ill patients.

Keywords: Sepsis; Proenkephalin; PENK; Biomarker; Mortality; Intensive Care; Prognosis

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