Presepsin levels in cirrhotic patients with bacterial infections and/or portal hypertension-related bleeding, presenting with or without acute kidney injury

Abstract

BackgroundBacterial infections in cirrhotic patients remain a challenge. Presepsin has been proposed as a valuable sepsis biomarker. We aimed to assess plasma presepsin levels in uncomplicated cirrhotic patients and to correlate them with liver disease severity and complicating events, defined as documented bacterial infection with or without concomitant portal hypertension-related bleeding, or bleeding without documented bacterial infection, with or without acute kidney injury.MethodsWe prospectively evaluated the presepsin levels of 108 consecutive uncomplicated cirrhotic patients with compensated (55, 50.9%) or decompensated (53, 49.1%) cirrhosis. During the follow up, 20 patients were reevaluated for a complicating event.ResultsMean baseline presepsin levels of the entire population were 440.4 pg/mL. Patients with decompensated cirrhosis exhibited significantly higher baseline levels than patients with compensated cirrhosis (599.1±492.2 vs. 287.5±130.5 pg/mL, P<0.001). In complicated cirrhotic patients, admission levels were remarkably higher than baseline (1438.0±1247.2 vs. 725.3±602.8 pg/mL, P<0.001), especially in those who developed acute kidney injury compared to those who did not (1827.3±1118.8 vs. 1048.7±1302.1 pg/mL, P<0.05). Baseline presepsin levels, using a cutoff of 607.5 pg/mL, could predict liver disease-related 3-month mortality with 77.8% sensitivity and 86.9% specificity: area under the receiver operating characteristic curve 0.825; 95% confidence interval 0.684-0.967; P<0.01.ConclusionsPlasma presepsin levels are elevated in uncomplicated cirrhotic patients, especially in those with advanced liver disease, and rise further in those complicated by an event. Baseline presepsin levels in cirrhotic patients could be used as an additional marker, along with the model for end-stage liver disease score, to predict short-term outcomes.

Evaluation of Serum Presepsin in the Diagnosis and the Prognosis of Cirrhotic Patients with Ascites

“…The median presepsin level in our results was in harmony with, Papp et al, and Fischer et al found that the level of serum presepsin was significantly higher in patients with infection as compared to those without [14]. Similarly, Elefsiniotis et al, and Okasha et al, found that patients with decompensated cirrhosis exhibited significantly higher baseline levels of presepsin than patients with compensated cirrhosis, especially in those who developed acute kidney injury compared to those who did not [15,16].…”

High Concentrations of Presepsin in the Bile and Its Marked Elevation in Biliary Tract Diseases: A Retrospective Analysis

“…Elefsiniotis et al reported that plasma presepsin levels were elevated in uncomplicated cirrhotic patients; they demonstrated that patients with decompensated liver disease (DLD) exhibited higher presepsin levels than patients with compensated liver disease (CLD; 441.0  442.5 vs. 262.0  179.0 pg/mL). In addition, patients with DLD exhibited higher T-BIL than patients with CLD (3.1  4.0 vs. 0.9  0.9) [19]. Based on these results, our study focused on presepsin levels in the bile.…”

Translocation of gut microbiota in liver cirrhosis: mechanisms, clinical significance, and markers

“…Важной особенностью является то, что исход ный уровень пресепсина у пациентов с неосложнен ным ЦП выше, чем в общей популяции. Согласно одному из опубликованных исследований, референт ные концентрации пресепсина у лиц в возрасте 18-72 лет без воспалительных заболеваний или бакте риальных инфекций составляют 55-184 пг/мл [79], тогда как у пациентов с ЦП среднее значение исход ного уровня пресепсина равно 440,4 пг/мл (медиана -335,0 пг/мл) [80]. В популяции пациентов с ЦП уровень пресепсина коррелирует со степенью декомпенсации (класс A по шкале Чайлд -Пью -361 пг/мл, класс B -530 пг/мл, класс C -703 пг/мл, р < 0,001) [81].…”