Presepsin teardown - pitfalls of biomarkers in the diagnosis and prognosis of bacterial infection in cirrhosis

Abstract

AIMTo evaluate the diagnostic and prognostic value of presepsin in cirrhosis-associated bacterial infections.METHODSTwo hundred and sixteen patients with cirrhosis were enrolled. At admission, the presence of bacterial infections and level of plasma presepsin, serum C-reactive protein (CRP) and procalcitonin (PCT) were evaluated. Patients were followed for three months to assess the possible association between presepsin level and short-term mortality.RESULTSPresent 34.7 of patients had bacterial infection. Presepsin levels were significantly higher in patients with infection than without (median, 1002 pg/mL vs 477 pg/mL, P < 0.001), increasing with the severity of infection [organ failure (OF): Yes vs No, 2358 pg/mL vs 710 pg/mL, P < 0.001]. Diagnostic accuracy of presepsin for severe infections was similar to PCT and superior to CRP (AUC-ROC: 0.85, 0.85 and 0.66, respectively, P = NS for presepsin vs PCT and P < 0.01 for presepsin vs CRP). At the optimal cut-off value of presepsin > 1206 pg/mL sensitivity, specificity, positive predictive values and negative predictive values were as follows: 87.5%, 74.5%, 61.8% and 92.7%. The accuracy of presepsin, however, decreased in advanced stage of the disease or in the presence of renal failure, most probably because of the significantly elevated presepsin levels in non-infected patients. 28-d mortality rate was higher among patients with > 1277 pg/mL compared to those with ≤ 1277 pg/mL (46.9% vs 11.6%, P < 0.001). In a binary logistic regression analysis, however, only PCT (OR = 1.81, 95%CI: 1.09-3.01, P = 0.022) but neither presepsin nor CRP were independent risk factor for 28-d mortality after adjusting with MELD score and leukocyte count.CONCLUSIONPresepsin is a valuable new biomarker for defining severe infections in cirrhosis, proving same efficacy as PCT. However, it is not a useful marker of short-term mortality.

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

“…In the analysis for 1-year mortality, only MELD score ≥15 and baseline presepsin ≥600 pg/mL were retained, whereas in the analysis for 3-month mortality, 1-year liver disease-related mortality and 3-month liver disease-related mortality, only baseline presepsin ≥600 pg/mL remained statistically significant. In a recent study by Papp et al , presepsin levels in cirrhotic patients failed to detect any prognostic relevance with respect to 1-month mortality after adjusting for MELD score [ 22 ]. These results are not discrepant with the findings of our study, since MELD score was included in our binary logistic regression analysis models only as a categorical variable (< or ≥15).…”

Development and Validation of a Clinical Predictive Model for Bacterial Infection in Hepatitis B Virus-Related Acute-on-Chronic Liver Failure

“…Moreover, a growing number of studies have attempted to explore novel biomarkers of bacterial infection. Soluble CD163 and presepsin were identified as useful markers for the detection of bacterial infection in patients with cirrhosis [ 21 , 22 ]. However, most studies have focused on the diagnosis, but not the prediction, of bacterial infection, which limits the early recognition and treatment of ACLF.…”

Bacterial infections in cirrhosis: a narrative review and key points for clinical practice

“…23 Other serum markers, like interleukin-6, Presepsin, the fluorescence intensity of mature neutrophils, showing some correlation with infections in cirrhosis, are not currently used in clinical practice. [24][25][26] Molecular biology tests to detect bacterial infections are promising, but there are few studies in the specific setting of cirrhosis. 27…”