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Pancreatic stone protein predicts hospital stay in community-acquired infections

Christos Michailides, Maria Lagadinou, Eleni Georgopoulou, Eirini Kechagia, Eleni Konstantina Velissari, Nikolaos Polychronopoulos, Foteini Tasouli, Christodoulos Chatzigrigoriadis, Dimitrios Velissaris, Markos Marangos

De Gruyter (2025)

Empirical-ClinicalObservational-CohortPDF AvailableGrade Eligible⚠️ Moderate Risk Flags

Overall Assessment

Limited Methodological Quality

Assessment created by PaperScorer AI v0 on Nov 24, 2025

D
40/100

Key Strengths

  • ✓Prospective ED cohort with clear eligibility and standardised PSP timing.
  • ✓Primary outcome prespecified; simple analyses reported.
  • ✓PSP showed strong AUC; consistent direction across methods.

Key Limitations

  • ⚠Small, single-centre; modest R² (0.159).
  • ⚠Limited confounder adjustment; no multiplicity control.
  • ⚠No preregistration or data/code availability.
  • ⚠Inconsistency in LRTI counts/percentages between text and Table 1.

Quality Dimensions

Bias & Integrity

COI handling, outcome switching, selective reporting

B70

Methods Rigour

Protocol clarity, sampling, controls

C58

External Validity

Generalisability, setting, population

C55

Transparency & Reproducibility

Data/code/materials availability, preregistration

F20

Significance & Novelty

Contribution vs prior art; context if known

C+60

Statistical Validity

Models, assumptions, multiplicity, CI priority

C55

Integrity & Transparency

Integrity checks

P-hacking risk?Review recommended
Outcome switching?None suspected
Conflict of interest?None suspected
Data integrity issues?Review recommended

Open science signals

Research dataNot shared
Analysis codeNot shared
Study materialsNot shared

Premise

Primary Research Question

Does PSP at ED admission predict length of stay in adult CAI patients?

Hypothesis

Higher PSP is associated with longer hospitalisation.

Hypothesis is Falsifiable

✓Yes

Correlation/ROC and regression can refute association.

PICO Framework

Population✓Yes

Adults with CAI (LRTI/UTI/IAI) in ED; explicit inclusion/exclusion.

Intervention—Not specified

No intervention; exposure is biomarker level.

Comparison✓Yes

PSP <50 vs ≥50 groups and continuous analyses.

Outcome✓Yes

LOS is clinically meaningful.

Literature Positioning

Literature Review Balanced

Well covered

Cites prior PSP sepsis/ED literature and mechanisms.

Evidence: Introduction; References 2–13

Research Gap Clearly Stated

Well covered

States limited evidence for PSP prognostic value in CAIs.

Evidence: Introduction

Stated Contribution Clear

Well covered

Evaluates association of admission PSP with LOS in CAIs.

Evidence: Abstract; Objectives

Study Provenance

Peer review unclearFunding disclosedNo conflicts declared3 affiliations listed
Authors & Affiliations
Dept. of Internal Medicine and Medical School, University Hospital/University of Patras, Greece.
Funding Statement
No funding was received for this work.
Conflicts of Interest
Authors declare no conflict of interest.
Peer Review
?Journal article; peer-review not stated in text.

Evidence: end matter

Methodological Assessment

Observational StudySTROBEObservational
10 applicable checklist items.
Yes 5 · No 3 · Unclear 2
Study Design & Definitions
✓
Participant Selection Described

Eligibility and exclusions detailed; single-centre ED cohort.

Evidence: Methods: eligibility/exclusions.

✓
Variable Definitions Clear

PSP device, timing, LOS defined; biomarkers listed.

Evidence: Methods: PSP measurement; Outcome.

✓
Confounding Addressed

Linear regression adjusted for age, sex, infection type only.

Evidence: Statistical Analysis; Results.

✓
Temporality Established

PSP measured at ED before LOS accrues.

Evidence: Methods: measured within 1 hour of admission.

✓
Exposure Definition Anchored

Exposure defined as single PSP value within 1h ED; anchored to presentation.

Evidence: Methods.

Bias Mitigation
✗
Balance Diagnostics Acceptable

No baseline balance by PSP groups presented.

Evidence: Results; no table of group characteristics.

?
Selection Bias Addressed

Consecutive sampling not stated; single-centre may bias.

Evidence: Methods.

?
Misclassification Assessed

No assay reproducibility or duplicate measures reported.

Evidence: Methods.

Robustness
✗
Negative Controls or E-value

No negative controls or E-values presented.

Evidence: Results.

✗
Model Diagnostics Reported

No regression diagnostics/assumptions or CI reported.

Evidence: Results.

Modules without applicable checklist items (8)

These designs were fully marked as not applicable but remain available for reference.

Abstract

4 9 50 101 Abstract Background Pancreatic Stone Protein (PSP) is an emerging biomarker for early detection and outcome prediction in infection sepsis. Objective To evaluate the association between PSP plasma measurements on Emergency Department (ED) admission subsequent hospital length of stay (LOS) among adults with community-acquired infections. Methods In this prospective observational study, patients presenting to ED respiratory, urinary or intra-abdominal infections had measured within one hour presentation. The primary was LOS (days). Association assessed using Spearman's rank correlation. A linear regression analysis performed demonstrating that only levels were significantly associated prolonged hospitalization, while compared groups (&lt; ng/ml vs ≥ ng/ml). Results positively correlated (Spearman's ρ = 0.369, p &lt; 0.001). Median days group (p Conclusions Elevated increased threshold identified at higher risk hospitalization. These results suggest could be a useful stratification resource planning, although validation multivariable adjustment confounding are needed.

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Study Overview

Study Design
Observational Cohort
Population
Adults ≥18 presenting to a Greek ED with community-acquired LRTI, UTI, or IAI; PSP measured on admission.
Sample Size
101
Study Arms
2 arms
Pre-registration
Not registered
Randomisation
None reported
Blinding
None
Analysis Set
Other
Follow-up
In-hospital until discharge; LOS in days.
Primary Outcome
Primary outcome was pre-specified in the protocol or registry.
Effect Size
Spearman rho; linear regression beta; ROC AUC: rho=0.369 (p<0.001); β(PSP)=0.041 (p<0.001); AUC(PSP)=0.910
Reviewer Notes
Prospective single-centre cohort measuring PSP at ED, observing LOS; no intervention.

Publication Details

DOI
10.2478/rjim-2025-0021
Published
November 14, 2025

External Resources

DOI LinkOpenAlex

Disclaimer: This assessment is generated by AI and should not be the sole basis for clinical or research decisions. Always review the original paper and consult with domain experts.