Usefulness of presepsin in the diagnosis of sepsis in patients with or without acute kidney injury

Abstract

BackgroundPresepsin is useful for differentiating sepsis from non-infection related systemic inflammatory response syndrome. However, there are no studies investigating the usefulness of presepsin in diagnosing sepsis involving patients with acute kidney injury (AKI). The purpose of this study is to determine levels of blood presepsin in patients with or without sepsis and among non-AKI patients or patients with different degrees of AKI severity.MethodsThis is a single center retrospective study. 247 patients admitted to the ICU between June 2010 and October 2012 were analyzed for their presepsin levels. We classified the patients into non-AKI and AKI according to the RIFLE (Risk, Injury, Failure, and Loss of kidney function and End-stage kidney disease or simply Loss and ESKD) criteria. We then sub-classified the patients in each group into either non-sepsis or sepsis sub-group and analyzed the accuracy of diagnosing sepsis based on their levels of presepsin.ResultsThe number of patients for each group was: non-AKI, 112; under AKI: Risk, 50; Injury, 36; Failure, 42; Loss and ESKD, 7. The levels of presepsin in sepsis groups were significantly higher than that in the non-sepsis group among the non-AKI, Risk and Injury patients (p < 0.0001, p < 0.01, p < 0.01, respectively). However, no significant difference in the level of presepsin between non-sepsis and sepsis groups among patients with Failure. In the receiver operating characteristic (ROC) analysis, the area under the curve (AUC) was 0.784 in the non-AKI group and 0.698 in the AKI comprising Risk, Injury and Failure groups. AUC value for non-AKI was not significantly different from that of AKI (p = 0.200). When 670 pg/mL was used as the cutoff value for presepsin, sensitivity and specificity were 70.3% and 81.3%, respectively. When 864 pg/mL was used as the cutoff value for presepsin, sensitivity and specificity were 71.4% and 63.8%, respectively.ConclusionsPresepsin level can be a reliable indicator of sepsis not only among non-AKI patients but also patients with less severe forms of AKI. However, it may not be a reliable indicator of sepsis in patients with a more advanced form of AKI.

Presepsin u akutnim i hroničnim poremećajima bubrežne funkcije

“…Relativno je mali broj studija koje su ispitivale korisnost određivanja PSP kod obolelih od ABI. Nivo PSP je značajno povišen kod septičnih bolesnika bez ABI, kao i obolelih od blažih formi ABI (RI po RIFLE ABI klasifikaciji) u poređenju sa ne-septičnim grupama 17,18 . Nivoi PSP u krvi mogu biti pouzdan indikator sepse ne samo kod ne-ABI bolesnika, već i kod obolelih sa nižim stadijumima ABI, ali svakako ne i kod obolelih sa višim stadijumima ABI, poput "FLE" stadijuma po RIFLE ABI klasifikaciji 18 .…”

“…Glomerular Filtration Rate, GFR) uzrokuje povećanje nivoa PSP u krvi, te stoga cut-offvrednosti PSP kod obolelih sa bubrežnom insuficijencijom treba obazrivo tumačiti 18,20 . Nivoi PSP su povišeni kod velikog broja obolelih sa GFR<60ml/min./1.73m 2 .…”

Use of Presepsin (Scd14-St) Аs A Marker оf Sepsis in Critical Conditions

“…Это открытие в дополнение к аномально высоким концентрациям пресепсина среди паци-ентов с терминальной стадией при острой почеч-ной недостаточности говорит о том, что почки являются основным органом, способствующим очищению крови от пресепсина. Учитывая, что у пациентов отделений интенсивной терапии весьма часто имеют место нарушения ренальной функции, при диагностике сепсиса необходимо принимать в расчет количественные показатели этих наруше-ний [8].…”

Presepsin u akutnim i hroničnim poremećajima bubrežne funkcije

“…Relativno je mali broj studija koje su ispitivale korisnost određivanja PSP kod obolelih od ABI. Nivo PSP je značajno povišen kod septičnih bolesnika bez ABI, kao i obolelih od blažih formi ABI (RI po RIFLE ABI klasifikaciji) u poređenju sa ne-septičnim grupama 17,18 . Nivoi PSP u krvi mogu biti pouzdan indikator sepse ne samo kod ne-ABI bolesnika, već i kod obolelih sa nižim stadijumima ABI, ali svakako ne i kod obolelih sa višim stadijumima ABI, poput "FLE" stadijuma po RIFLE ABI klasifikaciji 18 .…”