Presepsin and fetuin-A dyad for the diagnosis of proven sepsis in preterm neonates

Abstract

Background Diagnosis is the most strenuous step in the evaluation of neonatal sepsis. No gold standard diagnostic method is available except for blood culture. We aimed to investigate the role of positive and negative acute phase reactants, namely presepsin and fetuin-A, in the diagnosis of culture-proven late-onset sepsis. Methods A prospective, case-control study with the infants ≤32 weeks of age with a diagnosis of culture-proven late-onset sepsis was designed. Twenty-nine preterm infants with similar gestational and postnatal ages without sepsis constituted the control group. Serum values of presepsin, fetuin-A, C-reactive protein and interleukin-6 were evaluated at the enrollment, third and seventh days of the diagnosis in the infants with positive blood culture results. Results First-day presepsin values were significantly higher in the culture-positive infants than the control group [1583 ng/L (1023–1731) vs. 426 ng/L (287–589), p = < 0.0001]. Presepsin was found to have an 88.9% sensitivity and 88.9% specificity with a cut-off value of 823 ng/ml for culture-proven LOS in our study, and area under the receiver-operating curve was 0.939. Fetuin-A levels were similar between the study and control groups ( p > 0.05). Conclusion Presepsin may be an accurate marker for both diagnosis and monitoring of treatment response for culture-proven late-onset sepsis in preterm infants. However, fetuin-A does not seem to be a useful tool for the diagnosis of sepsis.

Presepsin level as risk factor for mortality in premature infants with neonatal sepsis

“…After being released from the cell surface, sCD14 is cleaved by the bacterial lysosomal enzyme into an N-terminal peptide of 64 amino acids, which is then called presepsin or sCD14-ST. 12 Increased presepsin level in the circulating blood reflects the severity of bacteremia, and is therefore a reliable diagnostic and prognostic marker of neonatal sepsis. 13 In the present study, we found an optimal presepsin cut-off value of 1057 ng/mL. At this value, an AUC of 0.804 was obtained, with a sensitivity of 60.71% and a specificity of 88.24% to predict mortality within seven days.…”

The Role and Validity of Diagnostic Biomarkers in Late-Onset Neonatal Sepsis

“…In 2019, Değirmencioğlu et al investigated presepsin, comparing it to fetuin-A dyad. While most of the studies on fetuin fetuin-A have been done on animals, the authors felt it important to compare it to presepsin because it showed a valid connection to sepsis -- its levels declining in early sepsis and then increasing at 72 hrs of inflammation [ 16 ]. It is postulated that fetuin-A plays a role in the immune system by inhibiting the release of late mediators of inflammation.…”

“…In contrast, fetuin-A levels were similar in both groups, suggesting it was not useful as a diagnostic marker. Overall, using a cut-off value of 823 ng/ml, the presepsin was found to have 88.9% sensitivity and 88.9% specificity [ 16 ].…”

“…These episodes were described as asymptomatic inflammation. While they can be attributed to possible maternal inflammation or the presence of mechanical ventilation, this should still be noted [ 16 ]. A strong limitation is that one of the studies lacked a control group [ 17 ].…”

Biomarkers for Point-of-Care Diagnosis of Sepsis

“…Similarly high performance of presepsin was demonstrated in individual studies by Montaldo and co-workers [79], with an AUC of 0.97, and Xian and colleagues [80], who reported an AUC of 0.942. A recent study by Deǧirmencioǧlu and co-workers [81] calculated an AUC of 0.939 for the diagnosis of late-onset sepsis in preterm neonates, which was slightly outperformed by IL-6 (AUC of 0.959). This was in contrast with the findings of Ahmed and co-workers [60] who found that presepsin was superior to IL-6 (AUCs of 0.934 and 0.751, respectively), although their study was focused on the diagnosis of early-onset sepsis.…”