Diagnostic and prognostic values of soluble CD14 (presepsin) in sepsis in pediatric intensive-care patients

Abstract

Background Early recognition and management of sepsis is a challenge facing intensivists. Many biomarkers were investigated but none is optimal. Aim Appraise the value of presepsin as a biomarker for the diagnosis, differentiation of severity, and prognosis of sepsis. Settings and design A prospective diagnostic test accuracy study performed in Mansoura University Children’s Hospital from April 2016 to April 2017. Patients and methods Plasma presepsin was estimated in 30 patients with sepsis on the first and third days from sepsis diagnosis (group A). Pediatric sequential organ failure assessment score, white blood cells count, and C-reactive protein were assessed on the same timing. Group B patients, 30 healthy patients, were assessed for presepsin level. IRB approved the study. Statistical analysis Independent sample t-test was performed to compare parametric data. Receiver operating characteristic curves were used to detect threshold values. Results A significantly higher presepsin level in the sepsis group (983 ng/l) compared with the healthy group (300 ng/l, P=0.001) was detected. A statistically significant higher serum presepsin level on day 3 was noticed in patients with severe sepsis opposed to sepsis and in nonsurvivors versus survivors (P=0.041 and 0.012, respectively). Receiver operating characteristic curve for plasma presepsin level on day 3 for the prediction of 30-days mortality was designed. Sensitivity and specificity were 86 and 73%, respectively, for a threshold point of 1300 ng/l [area under the curve (AUC)=0.820, P=0.001]. Conclusion Presepsin is a diagnostic marker for sepsis, a good discriminator of sepsis severity, and a sensitive predictor of 30-day mortality, but it should not be alone but in combination with other biomarkers.