Evaluation of presepsin as a diagnostic tool in newborns with risk of early-onset neonatal sepsis

Pospíšilová, Iva; Brodská, Helena; Bloomfield, Markéta; Borecka, Klara; Janota, J

doi:10.3389/fped.2022.1019825

Cited by 6 publications

(8 citation statements)

References 38 publications

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“…However, differences in presepsin concentrations between EOS and LOS cases and differences in reference ranges with increasing postnatal age underline the importance of studying them as separate entities [ 9 , 14 ]. To the best of our knowledge, only six previous studies reported diagnostic accuracy measures of presepsin specifically for EOS [ 13 , 19 , 20 , 21 , 22 , 23 ]. Five of these studies included only term-born infants [ 20 , 22 ] or mainly term-born infants [ 19 , 21 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, only six previous studies reported diagnostic accuracy measures of presepsin specifically for EOS [ 13 , 19 , 20 , 21 , 22 , 23 ]. Five of these studies included only term-born infants [ 20 , 22 ] or mainly term-born infants [ 19 , 21 , 23 ]. Three of these studies compared presepsin concentrations between clinical EOS cases and healthy controls without a suspicion of infection and reported AUC values of 0.77, 0.95 and 0.97, respectively [ 20 , 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…Popsilova et al (2023) included all infants with clinical signs of infection, but they excluded infants with possible EOS from their analysis. Presepsin could discriminate infants with probable EOS from infants with unlikely EOS, with an AUC of 0.85 [ 23 ]. Chen et al (2017) found an AUC of 0.96 in a cohort of infants with clinical EOS and infants without a suspicion of infection.…”

Section: Discussionmentioning

confidence: 99%

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Can Presepsin Be Valuable in Reducing Unnecessary Antibiotic Exposure after Birth?

et al. 2023

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Background: Due to a lack of rapid, accurate diagnostic tools for early-onset neonatal sepsis (EOS) at the initial suspicion, infants are often unnecessarily given antibiotics directly after birth. We aimed to determine the diagnostic accuracy of presepsin for EOS before antibiotic initiation and to investigate whether presepsin can be used to guide clinicians’ decisions on whether to start antibiotics. Methods: In this multicenter prospective observational cohort study, all infants who started on antibiotics for EOS suspicion were consecutively included. Presepsin concentrations were determined in blood samples collected at the initial EOS suspicion (t = 0). In addition to this, samples were collected at 3, 6, 12 and 24 h after the initial EOS suspicion and from the umbilical cord directly after birth. The diagnostic accuracy of presepsin was calculated. Results: A total of 333 infants were included, of whom 169 were born preterm. We included 65 term and 15 preterm EOS cases. At the initial EOS suspicion, the area under the curve (AUC) was 0.60 (95% confidence interval (CI) 0.50–0.70) in the term-born infants compared to 0.84 (95% CI 0.73–0.95) in the preterm infants. A cut-off value of 645 pg/mL resulted in a sensitivity of 100% and a specificity of 54% in the preterm infants. The presepsin concentrations in cord blood and at other time points did not differ significantly from the concentrations at the initial EOS suspicion. Conclusions: Presepsin is a biomarker with an acceptable diagnostic accuracy for EOS (culture-proven and clinical EOS) in preterm infants and might be of value in reducing antibiotic exposure after birth when appended to current EOS guidelines. However, the small number of EOS cases prevents us from drawing firm conclusions. Further research should be performed to evaluate whether appending a presepsin-guided step to current EOS guidelines leads to a safe decrease in antibiotic overtreatment and antibiotic-related morbidity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Can Presepsin Be Valuable in Reducing Unnecessary Antibiotic Exposure after Birth?

et al. 2023

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“…A recent evaluation has shown that the diagnostic efficacy of P-SEP was highest when used in combination with IL-6 and CRP compared when the biomarker was used alone. The area under the Rock curve (AUC) for discriminating the probable infection group from the unlikely infection group was 0.97 (95% CI: 0.911–0.990) vs. 0.845 (95% CI: 0.708–0.921) [ 202 ].…”

Section: Biomarkers Presently Used In Clinical Practicementioning

confidence: 99%

Biomarkers of Neonatal Sepsis: Where We Are and Where We Are Going

Boscarino,

Migliorino,

Carbone

et al. 2023

Antibiotics

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Neonatal sepsis is a bacterial bloodstream infection leading to severe clinical manifestations frequently associated with death or irreversible long-term deficits. Antibiotics are the drug of choice to treat sepsis, regardless of age. In neonates, the lack of reliable criteria for a definite diagnosis and the supposition that an early antibiotic administration could reduce sepsis development in children at risk have led to a relevant antibiotic overuse for both prevention and therapy. The availability of biomarkers of neonatal sepsis that could alert the physician to an early diagnosis of neonatal sepsis could improve the short and long-term outcomes of true sepsis cases and reduce the indiscriminate and deleterious use of preventive antibiotics. The main aim of this narrative review is to summarize the main results in this regard and to detail the accuracy of currently used biomarkers for the early diagnosis of neonatal sepsis. Literature analysis showed that, despite intense research, the diagnosis of neonatal sepsis and the conduct of antibiotic therapy cannot be at present decided on the basis of a single biomarker. Given the importance of the problem and the need to reduce the abuse of antibiotics, further studies are urgently required. However, instead of looking for new biomarkers, it seems easier and more productive to test combinations of two or more of the presently available biomarkers. Moreover, studies based on omics technologies should be strongly boosted. However, while waiting for new information, the use of the clinical scores prepared by some scientific institutions could be suggested. Based on maternal risk factors and infant clinical indicators, sepsis risk can be calculated, and a significant reduction in antibiotic consumption can be obtained.

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“…In neonates, two studies evaluated cutoff levels for diagnosing neonatal sepsis: the first established a cutoff value of 485 pg/mL, with 97.8% sensitivity and 94.1% specificity [11], and the second established a cutoff value of 538 ng/mL, with 79.5% sensitivity and 87.2% specificity [12]. Furthermore, in a recent study by Pospíšilová et al [13], P-SEP was evaluated as a potentially effective diagnostic tool for assessing the risk of early-onset neonatal sepsis in newborns.…”

Section: Introductionmentioning

confidence: 99%

Presepsin Levels in Pediatric Patients with Fever and Suspected Sepsis: A Pilot Study in an Emergency Department

Gatto,

Mantani,

Gola

et al. 2024

Children

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Sepsis is a life-threatening condition that affects 1.2 million children annually. Although there are several criteria for diagnosing this condition, signs are often nonspecific, and identifying sepsis is challenging. In this context, presepsin (P-SEP) seems to be a promising new biomarker since its plasma levels increase earlier than other sepsis-related proteins and its measurement is faster. We enrolled 157 minors who presented to the Pediatric Emergency Department of Agostino Gemelli Hospital with fever and suspected sepsis. Biochemical, anamnestic, and clinical data were collected. Viral agents were identified as the causative factor in 64 patients, who had an average P-SEP value of 309.04 pg/mL (SD ± 273.2), versus an average P-SEP value of 526.09 pg/mL (SD ± 657) found in 27 bacterial cases (p value: 0.0398). Four cases of overt sepsis had an average P-SEP value of 3328.5 pg/mL (SD ± 1586.6). The difference in P-SEP levels in viral versus bacterial infections was found to be statistically significant; therefore, P-SEP may have a central role in the evaluation of febrile children, helping clinicians distinguish between these two etiologies. Furthermore, amongst the cases of confirmed sepsis, P-SEP was always greater than 2000 pg/mL, while C-reactive protein and procalcitonin values appeared lower than what was considered significant.

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Evaluation of presepsin as a diagnostic tool in newborns with risk of early-onset neonatal sepsis

Cited by 6 publications

References 38 publications

Can Presepsin Be Valuable in Reducing Unnecessary Antibiotic Exposure after Birth?

Can Presepsin Be Valuable in Reducing Unnecessary Antibiotic Exposure after Birth?

Biomarkers of Neonatal Sepsis: Where We Are and Where We Are Going

Presepsin Levels in Pediatric Patients with Fever and Suspected Sepsis: A Pilot Study in an Emergency Department

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