Presepsin (Soluble CD14 Subtype): Reference Ranges of a New Sepsis Marker in Term and Preterm Neonates

Abstract

ObjectivePresepsin (soluble CD14 subtype) has been shown to be beneficial as a sepsis marker in adults. Nevertheless, very few data are available in neonates. The aim of the present study was to determine reference ranges of presepsin in term and preterm neonates.MethodsHealthy term neonates and preterm neonates without clinical signs of infection admitted to the Neonatal Unit were consecutively enrolled. Presepsin concentrations in whole blood were measured using a point-of-care assay system located in the Unit. Demographic data, antenatal and perinatal variables commonly affecting C-reactive protein and procalcitonin values were considered.ResultsOf the 684 neonates enrolled in the study, 484 (70.8%) were born at term and 200 (29.2%) were preterm (24–36 weeks’ gestation). In term infants, presepsin median value was 603.5 pg/mL (interquartile range: 466.5–791 pg/mL; 5th and 95th centiles: 315 and 1178 pg/mL respectively). In preterm infants, presepsin median value was slightly higher, equal to 620 pg/mL (interquartile range: 503–864 pg/mL; 5th and 95th centiles: 352 and 1370 pg/mL respectively). The reference ranges of presepsin we determined were much higher than those seen in healthy adults. No correlation between presepsin levels and postnatal age was observed, as well as no significant difference was demonstrated in preterm neonates at different gestational ages. None of the variables analyzed affected presepsin levels at a clinical significant extent.ConclusionFor the first time, this study provides reference ranges of presepsin in term and preterm neonates. Having reliable reference values is crucial for obtaining an adequate diagnostic accuracy. Based on our results, most variables commonly affecting C-reactive protein and procalcitonin values do not affect presepsin levels, which suggests that presepsin could be an effective sepsis marker. Further investigations in large groups of neonates with sepsis are needed to determine the diagnostic and prognostic value of this biomarker.

The Utility of Soluble CD14 Subtype in Early Diagnosis of Culture-Proven Early-Onset Neonatal Sepsis and Prediction of Outcome

“…The median (IQR) initial Tollner's score was 10 (8.5-12). The mean duration of inotropic support in shocked neonates was 7.2 AE 1.82 days, the median (IQR) duration of ventilation was 8 (5-9) days, and the median (IQR) duration of NICU admission was 20 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) days. ►Table 2 shows that neonates who needed mechanical ventilation had higher serum sCD14-ST levels on day 1 than those who did not need mechanical ventilation (p ¼ 0.001)…”

<p>Neonatal sepsis biomarkers: where are we now?</p>

“…70 Normal levels of presepsin in both healthy term and preterm infants have been measured. 71 The cutoff values used in various studies looking at the diagnostic capability of presepsin have varied widely: from as low as 539 pg/mL to 1,800 ng/mL. One of the advantages of presepsin as a diagnostic marker is the availability of automated testing using chemiluminescence that can provide results in as little as 15 minutes on blood specimens of only 100 µL.…”

“…One of the advantages of presepsin as a diagnostic marker is the availability of automated testing using chemiluminescence that can provide results in as little as 15 minutes on blood specimens of only 100 µL. 71 Although presepsin shows great promise, identification of reliable cutoff levels and testing of its utility in clinical decision-making is required before use becomes more widespread.…”

Presepsin as a predictor of positive blood culture in suspected neonatal sepsis

“…In the term infants, median P-SEP was 603.5 pg/ mL (IQR, 466.5-791 pg/mL; 5th and 95th percentiles: 315 and 1,178 pg/mL, respectively), and in preterm infants, median P-SEP was slightly higher at 620 pg/mL (IQR, 503-864 pg/mL; 5th and 95th percentiles: 352 and 1,370 pg/mL respectively). 17 In the present study, median P-SEP was 501 pg/mL (IQR, 391-604 pg/mL) on day 0 in the non-sepsis term group.…”