Diagnostic and prognostic value of presepsin and procalcitonin in non-infectious organ failure, sepsis, and septic shock: a prospective observational study according to the Sepsis-3 definitions

Abstract

Background We investigated the diagnostic and prognostic value of presepsin among patients with organ failure, including sepsis, in accordance with the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Methods This prospective observational study included 420 patients divided into three groups: non-infectious organ failure (n = 142), sepsis (n = 141), and septic shock (n = 137). Optimal cut-off values of presepsin to discriminate between the three groups were evaluated using receiver operating characteristic curve analysis. We determined the optimal cut-off value of presepsin levels to predict mortality associated with sepsis and performed Kaplan–Meier survival curve analysis according to the cut-off value. Cox proportional hazards model was performed to determine the risk factors for 30-day mortality. Results Presepsin levels were significantly higher in sepsis than in non-infectious organ failure cases (p < 0.001) and significantly higher in patients with septic shock than in those with sepsis (p = 0.002). The optimal cut-off value of the presepsin level to discriminate between sepsis and non-infectious organ failure was 582 pg/mL (p < 0.001) and between sepsis and septic shock was 1285 pg/mL (p < 0.001). The optimal cut-off value of the presepsin level for predicting the 30-day mortality was 821 pg/mL (p = 0.005) for patients with sepsis. Patients with higher presepsin levels (≥ 821 pg/mL) had significantly higher mortality rates than those with lower presepsin levels (< 821 pg/mL) (log-rank test; p = 0.004). In the multivariate Cox proportional hazards model, presepsin could predict the 30-day mortality in sepsis cases (hazard ratio, 1.003; 95% confidence interval 1.001–1.005; p = 0.042). Conclusions Presepsin levels could effectively differentiate sepsis from non-infectious organ failure and could help clinicians identify patients with sepsis with poor prognosis. Presepsin was an independent risk factor for 30-day mortality among patients with sepsis and septic shock.

Presepsin Predicts Severity and Secondary Bacterial Infection in COVID-19 by Bioinformatics Analysis

“…It can be used as a supplementary factor for stratifying sepsis patients with different prognosis groups [ 26 ]. In addition, presepsin is effective in distinguishing between infected and noninfectious organ failure and helps clinicians determine patient prognosis [ 28 ].…”

Presepsin as a Diagnostic and Prognostic Biomarker in Sepsis

“…The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of presepsin for diagnosing sepsis (including shock) using a cut-off value of 508 pg/ml were 87%, 86%, 93%, 76%, and 87%, respectively. A recently published study by Lee et al [68] performed the largest prospective observational study on the diagnostic value of presepsin in non-infectious organ failure, sepsis, and septic shock, in accordance with the latest Sepsis-3 definitions. They reported that presepsin has good accuracy in discriminating sepsis from non-infectious organ failure and had fair accuracy in discriminating septic shock from sepsis.…”

“…A recently published single-center prospective observational study by Lee et al [68] reported prognostic value of presepsin among patients with non-infectious organ failure, sepsis, and septic shock (in accordance with Sepsis-3 definition) in ED. They identified the most useful presepsin cut-off value (821 pg/ml) for the prediction of 30-day mortality among patients with sepsis and septic shock.…”

Use of infection biomarkers in the emergency department

“…Presepsin is one of the soluble forms of CD-14 and can be easily measured biochemically in serum, rises within 2 h after infection, and reaches its peak within 3 h; therefore, it is used as an early diagnostic and prognostic biomarker. [ 58 59 60 ] Presepsin was most frequently evaluated as a diagnostic biomarker in sepsis. The diagnostic sensitivity and specificity of presepsin in the diagnosis of sepsis were 0.94 (95% CI: 0.74–0.99) and 0.71 (95% CI: 0.35–0.92), respectively, and were superior to CRP and PCT in excluding sepsis.…”

“…[ 58 ] Presepsin cutoff values for sepsis, septic shock, and 30-day mortality prediction were 582 pg/mL ( P < 0.001), 1285 pg/mL ( P < 0.001), and 821 pg/mL ( P = 0.005), respectively. [ 60 ] In a small case–control study of sepsis patients, presepsin levels were higher in the group that did not survive the early (<1 day) and follow-up measures (up to 7 days), in contrast to PCT. [ 61 ] However, in the meta-analysis, there was no significant difference in presepsin levels between the survivor and nonsurvivor groups (mean difference: 0.92 [95% CI: 0.62–1.22]) in the random-effects model (I 2 = 79%, P < 0.01).…”