Presepsin as a Diagnostic and Prognostic Biomarker in Sepsis

Dimitrios Velissaris,Evangelos Karanikolas,Ioanna Koniari,Charalampos Pierrakos,Vasileios Karamouzos,Menelaos Karanikolas,Nicholas Zareifopoulos

doi:10.7759/cureus.15019

Abstract

Sepsis is a condition characterized by high morbidity and mortality which is commonly encountered in an emergency and critical care setting. Despite a substantial body of research, the ideal biomarker for the diagnosis and prognostic stratification of septic patients remains unknown. This review aimed to summarize the publications referring to the validity of the biomarker presepsin when used for the detection, monitoring and prognosis in patients suffering with sepsis.This work is a narrative review based on a PubMed/Medline search conducted in order to identify all relevant publications referring to the use of presepsin in sepsis. Search was not limited by year of publication so all articles archived in the database would be retrieved. No article from before 2010 was identified.A total of 57 publications of the last decade were included, all of which support the use of presepsin as a biomarker for the assessment of septic patients. It has been used alone or in combination with commonly used biomarkers in the evaluation of patients with sepsis in settings such as the emergency department and the intensive care unit. It is useful in the initial workup of patients with suspected sepsis in the emergency setting and may be a predictive factor of mortality and the most severe complication of sepsis.Presepsin seems to be a valuable tool for the laboratory workup of sepsis, especially when used in conjunction with other biomarkers and clinical rating scores with an established role in this population. Further research is needed to evaluate the clinical implications of utilizing presepsin measurements in the workup of sepsis.

Highlights

BackgroundSepsis is among the most common causes of death for hospitalized patients and despite recent progress mortality rates remain unacceptably high, especially if septic shock is present
It is hypothesized that it may be the ideal biomarker for diagnosing bacterial infection as it is directly implicated in the innate immune response and its concentration rises within hours of infection
A meta-analysis published in 2015 evaluated presepsin for the diagnosis of sepsis based on publications retrieved from medical databases until November 7, 2014

Summary

Introduction

BackgroundSepsis is among the most common causes of death for hospitalized patients and despite recent progress mortality rates remain unacceptably high, especially if septic shock is present. The pathogenesis of the syndrome involves a complex interplay between the pathogen (typically gram-negative bacteria) and the host immune response. Several biomarkers have been used in clinical practice for better monitoring, management and risk stratification of the sepsis syndrome. LPS is a component of the gram-negative bacterial cell wall which strongly stimulates innate immunity, contributing to the pathogenesis of sepsis. Because presepsin is elevated early during sepsis and is relatively specific for bacterial infection (due to its role in the pathogenesis of sepsis as a receptor for LPS), it may be useful in a clinical setting as a biomarker for the diagnosis and risk stratification

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