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Key messages What is already know on this subject
Serum Myeloperoxidase Index (MPXI) is elevated in infection and in hematologic disease. However, until now there has been no evaluation of the usefulness of MPXI for the differential diagnosis of systemic inflammatory response syndrome (SIRS) in emergency department. We hypothesized that serum MPXI could be used to differentiate between SIRS of infectious (sepsis) and non-infectious etiology.
What this study adds MPXI is higher in sepsis than in non-infectious SIRS. However, we found no evidence that MPXI provides useful additional diagnostic information to differentiate sepsis from non-infectious SIRS in emergency department.
Introduction
Myeloperoxidase (MPO), which is released by neutrophils, activates the synthesis of hypochlorous acid (HOCl) from hydrogen peroxide (H2 O2 ) and chloride ion (Cl- ). 1 HOCl plays an important role in defense against bacteria, fungi and viruses. 2 Neutrophils extracted from MPO-deficient individuals show lower microbicidal activity than those from individuals with normal MPO activity. 2-4 Serum MPO is elevated in infection and in haematological disease, such as acute myeloid leukaemia, chronic myeloid leukaemia, megaloblastic anaemia and during anticancer chemotherapy. 5-9
We hypothesised that there might be a difference in serum MPO between systemic inflammatory response syndrome (SIRS) of infectious (sepsis) and non-infectious aetiologies. In this study we therefore ascertained whether myeloperoxidase index (MPXI) is different in non-trauma adult emergency department (ED) patients with SIRS with or without an infectious aetiology and in the absence of haematological conditions known to affect MPXI.
Methods
Study design and data
This is a retrospective and observational study of 444 consecutive patients who met diagnostic criteria for SIRS from May 2012 to June 2012 in the ED of The Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University. The exclusion criteria was age <18 years, trauma, haematological disease, and being on anticancer chemotherapy. From May 2012 to June 2012, the total number of ED recruited patients was 6713. Of 6713 patients, 578 patients were in SIRS criteria and of 578 patients, 134 patients were excluded by exclusion criteria. Therefore, final inclusion patients were 444 patients.
SIRS was defined as presence of two or more of the following: (1) temperature >38°C or <36°C; (2) heart rate >90/min; (3) respiratory rate >20/min or PaCO2...