Potential Value of Presepsin Guidance in Shortening Antibiotic Therapy in Septic Patients: a Multicenter, Prospective Cohort Trial

Abstract

Long-term use of antibiotics for septic patients leads to bacterial resistance, increased mortality, and hospital stay. In this study, we investigated an emerging biomarker presepsin-guided strategy, which can be used to evaluate the shortening of antibiotic treatment in patients with sepsis without risking a worse outcome. Methods: In this multicenter prospective cohort trial, patients were assigned to the presepsin or control groups. In the presepsin group, antibiotics were ceased based on predefined cut-off ranges of presepsin concentrations. The control group stopped antibiotics according to international guidelines. The primary endpoints were the number of days without antibiotics within 28 days and mortality at 28 and 90 days. Secondary endpoints were the percentage of patients with a recurrent infection, length of stay in ICU and hospital, hospitalization costs, days of first episode of antibiotic treatment, percentage of antibiotic administration and multidrug-resistant bacteria, and SOFA score. Results: Overall, 656 out of an initial 708 patients were eligible and assigned to the presepsin group (n ¼ 327) or the control group (n ¼ 329). Patients in the presepsin group had significantly more days without antibiotics than those in the control group (14.54 days [SD 9.01] vs. 11.01 days [SD 7.73]; P < 0.001). Mortality in the presepsin group showed no difference to that in the control group at days 28 (17.7% vs. 18.2%; P ¼ 0.868) and 90 (19.9% vs. 19.5%; P ¼ 0.891). Patients in the presepsin group had a significantly shorter mean length of stay in the hospital and lower hospitalization costs than control subjects. There were no differences in the rate of recurrent infection and multidrug-resistant bacteria and the SOFA score tendency between the two groups. Conclusions: Presepsin guidance has potential to shorten the duration of antibiotic treatment in patients with sepsis without risking worse outcomes of death, recurrent infection, and aggravation of organ failure. Trial registration: ChiCTR, ChiCTR1900024391. Registered 9 July 2019-Retrospectively registered, http://www.chictr.org.cn

Prediction of Postoperative Sepsis Based on Changes in Presepsin Levels of Critically Ill Patients with Acute Kidney Injury after Abdominal Surgery

“…Because it can be induced by secondary response to pro-inflammatory cytokines, PCT has a limitation to be optimized early diagnostic marker of sepsis after abdominal surgery [ 22 ]. PSP, however, is the fragment of complex generated via direct interaction between a bacterial ligand, such as lipopolysaccharide, and the CD14 receptor of monocyte [ 6 , 26 , 27 ]. This immediate reaction enables the sensitive detection of bacterial infection and early diagnosis of sepsis [ 1 , 8 , 28 , 29 ].…”

Account of Deep Learning-Based Ultrasonic Image Feature in the Diagnosis of Severe Sepsis Complicated with Acute Kidney Injury

“…Early inflammatory responses released a large amount of proinflammatory cytokines and anti-inflammatory cytokines [ 8 ]. However, there is often an imbalance between proinflammatory factors and anti-inflammatory factors in sepsis patients, and the inflammatory reaction is out of control, which accelerates the development of sepsis [ 9 – 11 ]. In addition, inflammation often interacts with coagulation dysfunction and then influences the development of sepsis.…”

Presepsin as a Diagnostic and Prognostic Biomarker in Sepsis

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