الفهرس 
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Abstract
Sepsis represents acontinuum from an inciting infectious eventandthe consequent host-pathogen interaction ,possibly leading to hemodynamic consequences caused by pro-inflammatory, anti-inflammatory, and apoptotic mediators. In some cases sepsis can evolve into into septic shock, when hypotension becomes unresponsive to fluid therapy and vasopressor are required (113).
Early recognition of sepsis is not always straightforward and clinical signs at presentation can be misleading and very heterogeneous in the population, due to frequent Comorbidities or variable demographic characteristics (age, sex, ethnic group) (56).
Wetriedinourstudytoevaluatethevalueofmonitoringpresepsinlevel in critically ill patients for early diagnosis and differentiation between sepsis, and septic shock patients and to evaluate the prognostic value of monitoring presepsin level and its impact on mortality and to compare presepsin with CRP.
Weincludedagroupof10nonsepticpatientswhoservedascontrols& 40patientsthatweresub-classifiedinto19patientswithsepsisand21patients withsepticshockwhowerediagnosedaccordingtoSepsis3declaredin2016
.
Serum samples for both presepsin and CRP were withdrawn on 0 day and 5th day from ICU admission and withdrawn once from controls.
We found that the Presepsin and CRP were higher in Septic patients than controls with significant P value of less than 0.01 for both markers So Presepsin & CRP could be considered diagnostic markers for Sepsis .
We found a significant correlation between Presepsin and APACHEII score with significant P value of 0.04. so Presepsin could be postulated as a good indicator for mortality on admission .
We found a significant correlation between CRP 5 & SOFA 5 with p value of 0.03
WefoundasignificantcorrelationbetweenPresepsin5&SOFA5with p value of0.01
So both markers are of good value for follow up of septic patients
We found that Presepsin 5 and CRP 5 were statistically higher in patientswithsepticshockthanpatientswithSepsiswithsignificantpvalueof
0.001 of both.
WefoundthatPresepsin5wasstatisticallyhigherinPatientswhowere ventilated or on Vasopressors than other non-ventilated or on vasopressors with significant p value of 0.004 & 0.001respectively.
We found that CRP 5 was statistically higher in patients ventilated or on Vasopressors than non-ventilated patients or on vasopressors with significant p value of 0.009 & 0.003 respectively.
So both markers could be good indicators for detection of sepsis severity
We found that Presepsin 5 and CRP 5 were significantly higher in survivors than non survivors with significant p value of less than 0.001 of both. So both markers could beusedas good indicators of mortalitydetecting
Roc curve was calculated for the use of Presepsin and CRP as diagnostic
tool for sepsis and septic shock the cut-off point was ≥ 1346.5 pg/ml for presepsin and ≥ 140 mg/l for CRP
Also; ROC curve was calculated for the use of Presepsin and CRP as predictors of mortality with cut-off point of ≥1262 Pg/l and≥ 114 mg/l respectively.