Presepsin (sCD14-ST), an innate immune response marker in sepsis

Presepsin for the detection of early-onset sepsis in preterm newborns

BACKGROUND

Early-onset sepsis (EOS) is responsible for an important fraction of neonatal morbidity and mortality all over the world. The aim of this study was to assess whether presepsin (P-SEP) can be a more accurate biomarker of EOS compared with pro-calcitonin (PCT) and C-reactive protein (CRP).

STUDY DESIGN

Consecutive preterm neonates (<34 wk gestational age, admitted to Neonatal Intensive Care Unit by 6 h of age and undergoing sepsis evaluation) were recruited as part of a case-matched control study. We determined CRP, PCT and P-SEP at admission, and then at 12, 24, and 48 h of age. Neonates recruited into the study were divided into the EOS group (n = 32) and the uninfected group (n =38) according to their infection screening.

RESULTS

P-SEP values were significantly higher in the EOS group than in the uninfected group at different time intervals. The highest accuracy was achieved by P-SEP at 24 h after birth. The AUC for P-SEP was 0.97. In our sample, P-SEP achieved the best accuracy for prediction of EOS at the cut-off of 788 ng/l with 93% sensitivity and 100% specificity.

CONCLUSIONS

This study shows that P-SEP is significantly higher in preterm infants with EOS compared with uninfected infants.

Diagnostic performance of procalcitonin, presepsin, and C-reactive protein in patients with hematological malignancies

INTRODUCTION

Infections represent a major complication of hematological malignancies. C-reactive protein (CRP) and procalcitonin (PCT) have been used as diagnostic biomarkers of infections, but do not produce definitive findings. Recently, a new biomarker, presepsin, has been used as a diagnostic tool for detecting infections in the fields of emergency and neonatal medicine. However, the usefulness of presepsin for identifying infections in patients with hematological malignancies, including those who develop febrile neutropenia, remains unclear.

METHODS

In this study, we retrospectively analyzed the utility of PCT, presepsin, and CRP as biomarkers of infections during 49 febrile episodes that occurred in 28 patients with hematological malignancies.

RESULTS

The levels of PCT, but not those of CRP or presepsin, were significantly higher in the infection group than in the uninfected group (P<.03), indicating that PCT might be a more sensitive biomarker of infections. No differences in presepsin levels were detected between the patients with and without neutropenia, or between the infected and uninfected patients with neutropenia, indicating that presepsin might have less diagnostic value in patients with neutropenia.

CONCLUSIONS

We conclude that PCT might provide additional information and could be used in combination with other biomarkers to detect infections in patients with hematological malignancies.

Evaluating the value of dynamic procalcitonin and presepsin measurements for patients with severe sepsis

OBJECTIVE

This study comparatively evaluated the value of dynamic procalcitonin (PCT) and presepsin measurements in assessing therapeutic efficacy and prognosis for patients with severe sepsis.

METHODS

Patients with severe sepsis (n=109) were enrolled and divided into survival and non-survival groups based on 90-day survival. PCT and presepsin levels were evaluated on days 1, 3, 5, 7, and 12. Sequential organ failure assessment (SOFA) was calculated.

RESULTS

PCT from day 5 onward was weakly to moderately positively correlated with SOFA, whereas presepsin from day 3 onward was positively correlated. From day 5 onward, the clearance ratio (CR) of PCT was weakly to moderately negatively correlated with SOFA, while the CR of presepsin was strongly negatively correlated as early as day 3. PCT levels had no statistical difference between survival and non-survival groups. Within 12days, PCT levels in both survival and non-survival groups decreased synchronously. Comparatively, presepsin levels in the survival group decreased persistently, while they rose gradually in the non-survival group. CRs of PCT in the survival group were higher than those in the non-survival group on days 3, 5, 7, and 12. However, CRs of PCT rose synchronously in both groups. Comparatively, CRs of presepsin in the survival group rose persistently, while they decreased gradually in the non-survival group.

CONCLUSIONS

Dynamic monitoring of presepsin and PCT demonstrated that both presepsin and CR of presepsin are continuous and better markers than are PCT and CR of PCT for evaluating the therapeutic efficacy and prognosis of patients with severe sepsis.

Serial measurement of presepsin, procalcitonin, and C-reactive protein in the early postoperative period and the response to antithymocyte globulin administration after heart transplantation

Differentiation between systemic inflammatory response syndrome and sepsis in surgical patients is of crucial significance. Procalcitonin (PCT) and C-reactive protein (CRP) are widely used biomarkers, but PCT becomes compromised after antithymocyte globulin (ATG) administration, and CRP exhibits limited specificity. Presepsin has been suggested as an alternative biomarker of sepsis. This study aimed to demonstrate the role of presepsin in patients after heart transplantation (HTx). Plasma presepsin, PCT, and CRP were measured in 107 patients serially for up to 10 days following HTx. Time responses of biomarkers were evaluated for both noninfected (n=91) and infected (n=16) patients. Areas under the concentration curve differed in the two groups of patients for presepsin (P<.001), PCT (P<.005), and CRP (P<.001). The effect of time and infection was significant for all three biomarkers (P<.05 all). In contrast to PCT, presepsin was not influenced by ATG administration. More than 25% of noninfected patients had PCT above 42 μg/L on the first day, and the peak concentration of CRP in infected patients was reached on the third post-transplant day (median 135 mg/L). Presepsin seems to be as valuable a biomarker as PCT or CRP in the evaluation of infectious complications in patients after HTx.

Evaluation of Prognostic Impact of Soluble CD14 in B-Chronic Lymphocytic Leukemia

sCD14 is an acute phase reactant; few studies reported its prognostic value in B-CLL patients. This gave us the impetus to conduct this study. This study enrolled 40 newly diagnosed B-CLL Egyptian patients, presented to the Hematology Department of the Medical Research Institute in Alexandria University. The ZAP-70 was determined by flow cytometry whereas serum sCD14 concentration by human sCD14 sandwich ELISA method. The mean serum level of sCD14 was significantly higher among patients with positive ZAP-70, Binet stage C, Rai stage III-IV and high risk CLL prognostic index. It showed a significant positive correlation to the percentage of ZAP-70 expression and significant negative correlation to the hemoglobin concentration. Serum sCD14 concentration could be used to assess B-CLL patients initially as an additional prognostic marker, especially in low resources areas where flow cytometry is not available.

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

AIM

To evaluate the diagnostic and prognostic value of presepsin in cirrhosis-associated bacterial infections.

METHODS

Two 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.

RESULTS

Present 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.

CONCLUSION

Presepsin 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.

Diagnostic and prognostic value of soluble CD14 subtype (Presepsin) for sepsis and community-acquired pneumonia in ICU patients

Background

The soluble CD14 subtype, Presepsin, appears to be an accurate sepsis diagnostic marker, but data from intensive care units (ICUs) are scarce. This study was conducted to evaluate the diagnostic and prognostic value of Presepsin in ICU patients with severe sepsis (SS), septic shock (SSh) and severe community-acquired pneumonia (sCAP).

Methods

Presepsin and procalcitonin (PCT) levels were determined for patients at admission to ICU. Four groups have been differentiated: (1) absence or (2) presence of systemic inflammatory response syndrome, (3) SS or (4) SSh; and 2 groups, among the patients admitted for acute respiratory failure: absence or presence of sCAP. Biomarkers were tested for diagnosis of SS, SSh and sCAP and for prediction of ICU mortality.

Results

One hundred and forty-four patients were included: 44 SS and 56 SSh. Plasma levels of Presepsin and PCT were significantly higher in septic than in non-septic patients and in SSh as compared to others. The sepsis diagnostic accuracy of Presepsin was not superior to that of PCT (AUC: 0.75 vs 0.80). In the 72/144 patients admitted for acute respiratory failure, the capability of Presepsin to diagnose sCAP was significantly better than PCT. Presepsin levels were also predictive of ICU mortality in sepsis and in sCAP patients.

Conclusion

Plasma levels of Presepsin were useful for the diagnosis of SS, SSh and sCAP and may predict ICU mortality in these patients.

Presepsin is an early monitoring biomarker for predicting clinical outcome in patients with sepsis

Despite their undoubted helpfulness in diagnosing sepsis, increased blood C-reactive protein (CRP) and procalcitonin (PCT) levels have been described in many noninfectious conditions. Presepsin is a soluble fragment of the cluster of differentiation 14 involved in pathogen recognition by innate immunity. We aimed to investigate the diagnostic and prognostic performance of presepsin in comparison to PCT and CRP in patients presenting with systemic inflammatory response syndrome (SIRS) and suspected sepsis. Seventy-six subjects were enrolled in this study, including 51 patients with SIRS as well as 25 healthy subjects. Plasma presepsin, PCT and CRP levels were serially measured on admission and at days 1, 3, 7 and 15. Presepsin and PCT yielded similar diagnostic accuracy, whereas presepsin performed significantly better than CRP. Presepsin and PCT showed comparable performance for predicting 28-day mortality, and both biomarkers performed significantly better than CRP. In septic patients, presepsin revealed earlier concentration changes over time when compared to PCT and CRP. Presepsin and PCT could differentiate between septic and non-septic patients with comparable accuracy and both biomarkers showed similar performance for predicting 28-day mortality. Early changes in presepsin concentrations might reflect the appropriateness of the therapeutic modality and could be useful for making effective treatment decisions.

Diagnostic value of levels of presepsin (soluble CD14-subtype) in febrile neutropenia in patients with hematological disorders

BACKGROUND

Whether presepsin (soluble CD14-subtype) is better than other markers including procalcitonin (PCT), has not been adequately investigated in febrile neutropenia (FN).

METHODS

We prospectively examined the utility of presepsin in FN in Cohort 1 (C1) and 2 (C2), between November 2010 and February 2012, and between November 2013 and January 2014, respectively. The purpose of this study was to investigate 1) the relative value of serum presepsin over serum PCT in C1, and 2) the relative value of plasma presepsin as compared with serum PCT, C-reactive protein, interleukin-6 and interleukin-8 with frequent, repeated sampling in C2.

RESULTS

Seventy-nine FN episodes (C1, 75; C2, 4) were evaluable. In C1, when compared with control values, presepsin was significantly higher at onset of FN (P = 0.004), while PCT was not significantly higher (P = 0.54). The median value of serum presepsin within 72 h of onset of FN in subjects with fever of unknown origin, local infection, bacteremia and septic shock was 680 (reference 314) pg/ml, 763, 782 and 1359, respectively. In C2, the mean levels of plasma presepsin from onset of FN to 72 h were classified as negative in the two patients with no suspected site of infection, and those of the remaining two patients with clinically probable infections were positive (175, 131, 346 and 329 pg/ml, respectively). In contrast, the other markers did not discriminate between this two groups.

CONCLUSIONS

In FN, presepsin may be an earlier and more sensitive indicator of bacterial infection than PCT.

Diagnostic accuracy of presepsin (sCD14-ST) and procalcitonin for prediction of bacteraemia and bacterial DNAaemia in patients with suspected sepsis

Early diagnosis and prompt targeted therapy are essential for septic patients' outcome. Procalcitonin (PCT) has been shown to predict bacteraemia and bacterial DNAaemia. Presepsin, the circulating soluble form of CD14 subtype, increases in response to bacterial infections, and is considered a new, emerging, early marker for sepsis. We evaluated the diagnostic accuracy of presepsin in predicting bacteraemia and bacterial DNAaemia in 92 patients with suspected sepsis, and we compared it with that of PCT and C-reactive protein (CRP). Presepsin median values were significantly higher in bacteraemic vs non-bacteraemic patients [1290 pg ml-1, interquartile range (IQR) 1005-2041 vs 659 pg ml-1, IQR 381-979; P<0.001] and in patients with vs patients without bacterial DNAaemia (1297 pg ml-1, IQR 1001-2046 vs 665 pg ml-1, IQR 381-940; P<0.001). Receiver operating characteristics analysis showed an area under the curve (AUC) for presepsin of 0.788 [95 % confidence interval (CI): 0.687-0.889; P<0.001] in predicting bacteraemia and of 0.777 (95 % CI: 0.676-0.878; P<0.001) in predicting bacterial DNAaemia, lower, but not significantly different, than those of PCT (0.876, P=0.12 and 0.880, P=0.07, respectively). Both biomarkers performed significantly better than CRP, which had an AUC for bacteraemia of 0.602 and for DNAaemia of 0.632 (all P values <0.05). In conclusion, in patients with suspected sepsis, presepsin and PCT showed a good diagnostic accuracy in predicting both bacteraemia and bacterial DNAaemia, superior to CRP.

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

OBJECTIVE

Presepsin (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.

METHODS

Healthy 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.

RESULTS

Of 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.

CONCLUSION

For 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.