Role of presepsin for the evaluation of sepsis in the emergency department

Abstract

Sepsis, severe sepsis and septic shock are among the most common conditions handled in the emergency department (ED). According to new Sepsis Guidelines, early diagnosis and treatment are the keys to improve survival. Plasma C-reactive protein (CRP) and procalcitonin (PCT) levels, when associated with documented or suspected infection, are now part of the definitions of sepsis. Blood culture is the gold standard method for detecting microorganisms but it requires too much time for results to be known. Sensitive biomarkers are required for early diagnosis and as indexes of prognosis sepsis. CRP is one of the acute phase proteins synthesized by the liver: it has a great sensitivity but a very poor specificity for bacterial infections. Moreover, the evolution of sepsis does not correlate with CRP plasma changes. In recent years PCT has been widely used for sepsis differential diagnosis, because of its close correlation with infections, but it still retains some limitations and false positivity (such as in multiple trauma and burns). Soluble CD14 subtype (sCD14-ST), also known as presepsin, is a novel and promising biomarker that has been shown to increase significantly in patients with sepsis, in comparison to the healthy population. Studies pointed out the capability of this biomarker for diagnosing sepsis, assessing the severity of the disease and providing a prognostic evaluation of patient outcome. In this mini review we mainly focused on presepsin: we evaluate its diagnostic and prognostic roles in patients presenting to the ED with systemic inflammatory response syndrome (SIRS), suspected sepsis or septic shock.

Usefulness of several biomarkers in the management of septic patients: C-reactive protein, procalcitonin, presepsin and mid-regional pro-adrenomedullin

“…C-reactive protein (CRP) and procalcitonin (PCT) are among the most extensively studied in recent years, and the ones with the widest available literature. Nevertheless, this is not the case with mid-regional pro-adrenomedullin (MR-proADM) and presepsin, also known as soluble fragment of the cluster-of differentiation marker protein 14 (SCD14-ST) [8][9][10][11]. In addition to the diagnostic (including positive and negative predictive values) and prognostic usefulness of these four biomarkers, it would also be interesting to know in what aspects they overlap and/or differ, and if some of them could offer additional information about the germen responsible for the septic process, or about their ability to differentiate between sepsis and SSh at an early stage.…”

Lipopolysaccharide-pathway proteins are associated with gallbladder cancer among adults in Shanghai, China with mediation by systemic inflammation

“…However, new pre-treatment kits have become available to improve LPS detection. In addition, two LPS-pathway proteins, including cluster of differentiation 14 (CD14) and LPS-binding protein (LBP), may serve as indirect measures of response to the LPS endotoxin [19, 20]. Thus, examining plasma levels of these LPS-pathway proteins may provide insight into the role of bacterial infection in GBC etiology.…”

Diagnostic and prognostic potential of presepsin in Emergency Department patients presenting with systemic inflammatory response syndrome

“…Masson et al previously calculated a cut-off level of 1631 pg/mL for 28-and 90-day survival in ICU patients with severe sepsis or septic shock. 9 Diagnostic cut-off values have been markedly lower: 600 pg/mL has been suggested for differentiation between patients with suspected but culture-negative sepsis and those with culture-proven sepsis 8 and 729 pg/mL for differentiation between SIRS patients with bacteremia and those without. 7 In conclusion, presepsin may be useful for prediction of 30-and 90 day mortality as well as ICU-admission in patients with SIRS at the ED while PCT was the most promising diagnostic biomarker for BSI.…”