Diagnostic and prognostic value of presepsin in the management of sepsis in the emergency department: a multicenter prospective study

Abstract

IntroductionSepsis, severe sepsis and septic shock are common conditions with high mortality. Their early diagnosis in the Emergency Department (ED) is one of the keys to improving survival. Procalcitonin (PCT) has been used as a biomarker in septic patients but has limited specificity and can be elevated in other scenarios of systemic inflammatory response syndrome (SIRS). Soluble CD14 (sCD14) or presepsin is the free fragment of a glycoprotein expressed on monocytes and macrophages. Preliminary reports suggest that levels of presepsin are significantly higher in septic patients than in healthy individuals. The aim of this study is to investigate the diagnostic and prognostic value of presepsin compared to PCT in people presenting at the ED with SIRS and suspected sepsis or septic shock.MethodsThis study was conducted in two major hospitals in Turin, Italy. One hundred six patients presenting to the EDs with suspected sepsis or septic shock were included, and another eighty-three patients affected by SIRS, but with no clinical evidence of infection, were recruited as controls. Blood samples were collected at first medical evaluation and for some patients after 24 and 72 h. The samples were analyzed using the PATHFAST Presepsin assay for sCD14, and commercial kits were used for other determinations (for example, PCT). Definitive diagnosis and survival rates were obtained afterward by analysis of digital medical records.ResultsElevated concentrations of presepsin at presentation were observed in septic patients compared to control patients. The same trend was observed for mean values of PCT. Higher values of presepsin were observed in septic patients at presentation (time 0). The diagnostic accuracy of PCT was generally higher, and areas under the curve (AUCs) were 0.875 for PCT and 0.701 for presepsin. Mean presepsin values were significantly higher in nonsurvivor septic patients (60-day mortality) than in survivors. No significant correlation was noted between PCT and survival.ConclusionsIn our experience, presepsin was useful in the early diagnosis of infection in a complex population of patients with SIRS, sepsis, severe sepsis and septic shock who presented to the ED. Presepsin showed a significant prognostic value, and initial values were significantly correlated with in-hospital mortality of patients affected by sepsis, severe sepsis or septic shock.

Circulating presepsin (soluble CD14 subtype) as a marker of host response in patients with severe sepsis or septic shock: data from the multicenter, randomized ALBIOS trial

“…During recognition of PAMPs by soluble CD14, a 13-kDa fragment is formed, named sCD14 subtype (sCD14-ST) or presepsin [10]. Presepsin is emerging as a novel circulating marker of sepsis [10][11][12][13][14][15]. However, like other candidates in sepsis, this biomarker needs to be validated in large, multicenter studies with representative populations [3].…”

Utility of presepsin (sCD14-ST) as a diagnostic and prognostic marker of sepsis in the emergency department

“…PSEP concentrations correlated with the severity of sepsis and outcome, suggesting that PSEP may be a promising biomarker and indicator of systemic infections or sepsis and a marker candidate for prognosis and therapy monitoring [7][8][9]. Additionally, a recent multicenter trial demonstrated a high prognostic value of PSEP for mortality prediction in patients with severe sepsis and septic shock.…”

“…A recent study of patients presenting at the ED with suspected sepsis or septic shock showed that PSEP concentration at presentation was associated with 60-day mortality (7). A case-control study of a multicenter clinical trial enrolling patients with severe sepsis or septic shock showed that early PSEP was significantly higher in decedents than in survivors, while PCT was not (10).…”

Are there new approaches for diagnosis, therapy guidance and outcome prediction of sepsis?

“…RAGE is upregulated in various inflammatory diseases, such as rheumatoid arthritis [57,58] , inflammatory kidney disease [59,60] , arteriosclerosis [61] and inflammatory [71,72] . Presepsin is a promising biomarker for diagnosing sepsis, severe sepsis and septic shock compared to other biomarkers such as PCT [73][74][75][76] and seems specific for infectious diseases [71] . High plasma levels in septic patients can be detected 6 h after early onset [72] .…”