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Early diagnosis of sepsis is essential for a favorable disease outcome. The aim of this study was to evaluate the association of initial and subsequent presepsin concentrations with sepsis outcomes.
Methods:
One hundred sepsis patients were enrolled in the study from two different university centers. Four times during study, concentrations of presepsin, procalcitonin (PCT), and C-reactive protein (CRP) were measured, and Sequential Organ Failure Assessment (SOFA) score and Acute Physiology and Chronic Health Evaluation (APACHE II) score were calculated. Patients were grouped into survivors and nonsurvivors. A sandwich ELISA kit was used to measure presepsin concentrations. To test the changes in biomarkers concentrations and SOFA score and APACHE II score during the disease course and to estimate the differences between outcome groups, generalized linear mixed effects model was used. Receiver operating characteristic curve analysis was performed to determine the prognostic value of presepsin concentrations.
Results:
Initial values of presepsin, SOFA score, and APACHE II score were significantly higher in nonsurvivors compared to survivors. Concentrations of PCT and CRP did not differ significantly between outcome groups. ROC curve analyses show a greater predictive ability of initial presepsin concentrations for predicting mortality compared to subsequent measurements of presepsin concentrations.
Conclusions:
Presepsin has a good ability to predict mortality. Initial presepsin concentrations better reflects poor disease outcome compared to presepsin concentrations 24 and 72 hours after admission.
Chapter 4 tests the delegation theory by applying it to a number of hypothetical case studies involving actual situations that have been considered by the ICC. Specifically, it uses scenarios that potentially involve procedural immunities to explore whether delegation of jurisdiction provides a legal basis for the ICC’s jurisdiction in different situations that could come before the Court via a State referral or Prosecutor-initiated investigation. The first case study is a hypothetical scenario in which a sitting Head of State from a non-State Party is wanted by the ICC for the commission of crimes on the territory of a State Party. Incumbent Heads of State are immune from prosecution in foreign domestic courts, which raises the question of how States Parties can be said to delegate jurisdiction to the ICC, when the exercise of such jurisdiction would be unlawful in the domestic context. The second and third case studies use the situations in Afghanistan and Palestine, each of which raises potential obstacles relating to curtailed domestic jurisdiction that could affect whether the ICC is able to lawfully prosecute nationals of non-States Parties for crimes committed on those territories.
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