Diagnostic and prognostic value of presepsin vs. established biomarkers in critically ill patients with sepsis or systemic inflammatory response syndrome:

Helena Brodska; Jiri Valenta; Kveta Pelinkova; Zdenek Stach; Robert Sachl; Martin Balik; Tomas Zima; Tomas Drabek

doi:10.1515/cclm-2017-0839

Published by De Gruyter November 25, 2017

Diagnostic and prognostic value of presepsin vs. established biomarkers in critically ill patients with sepsis or systemic inflammatory response syndrome

Helena Brodska , Jiri Valenta , Kveta Pelinkova , Zdenek Stach , Robert Sachl , Martin Balik , Tomas Zima and Tomas Drabek

From the journal Clinical Chemistry and Laboratory Medicine (CCLM)

https://doi.org/10.1515/cclm-2017-0839

Showing a limited preview of this publication:

Abstract

Background:

Inflammatory biomarkers may aid to distinguish between systemic inflammatory response syndrome (SIRS) vs. sepsis. We tested the hypotheses that (1) presepsin, a novel biomarker, can distinguish between SIRS and sepsis, and (2) higher presepsin levels will be associated with increased severity of illness and (3) with 28-day mortality, outperforming traditional biomarkers.

Methods:

Procalcitonin (PCT), C-reactive protein (CRP), presepsin, and lactate were analyzed in 60 consecutive patients (sepsis and SIRS, n=30 per group) on day 1 (D1) to D3 (onset sepsis, or after cardiac surgery). The systemic organ failure assessment (SOFA) score was determined daily.

Results:

There was no difference in mortality in sepsis vs. SIRS (12/30 vs. 8/30). Patients with sepsis had higher SOFA score vs. patients with SIRS (11±4 vs. 8±5; p=0.023), higher presepsin (AUC=0.674; p<0.021), PCT (AUC=0.791; p<0.001), CRP (AUC=0.903; p<0.0001), but not lactate (AUC=0.506; p=0.941). Unlike other biomarkers, presepsin did not correlate with SOFA on D1. All biomarkers were associated with mortality on D1: presepsin (AUC=0.734; p=0.0006; best cutoff=1843 pg/mL), PCT (AUC=0.844; p<0.0001), CRP (AUC=0.701; p=0.0048), and lactate (AUC=0.778; p<0.0001). Multiple regression analyses showed independent associations of CRP with diagnosis of sepsis, and CRP and lactate with mortality. Increased neutrophils (p=0.002) and decreased lymphocytes (p=0.007) and monocytes (p=0.046) were also associated with mortality.

Conclusions:

Presepsin did not outperform traditional sepsis biomarkers in diagnosing sepsis from SIRS and in prognostication of mortality in critically ill patients. Presepsin may have a limited adjunct value for both diagnosis and an early risk stratification, performing independently of clinical illness severity.

Keywords: biomarker; mortality; outcome; sepsis; soluble cluster of differentiation 14 subtype; systemic inflammatory response syndrome

Corresponding author: Tomas Drabek, MD, PhD, Department of Anesthesiology, University of Pittsburgh School of Medicine, UPMC Presbyterian Hospital, 200 Lothrop St. Suite C220, Pittsburgh, PA 15213, USA, Phone: +(1) 412-647-1687

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: Supported by the Research Project PROGRES Q 25 of the Charles University in Prague, Czech Republic, by RVO VFN 64165 of the General University Hospital in Prague, Czech Republic, and by the European Union’s Horizon 2020 Research and Innovation Programme under grant agreement no. 687697 (www.SmartDiagnos.eu).
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Supplemental Material:

The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2017-0839).

Received: 2017-9-15

Accepted: 2017-10-22

Published Online: 2017-11-25

Published in Print: 2018-3-28