Plasma Presepsin Research Articles

Presepsin as a biomarker in perioperative medicine.

Presepsin is the soluble fragment of CD14, a multifunctional glycoprotein expressed on the surface of innate immune cells. In healthy individuals, presepsin is present in very low concentrations with reference values ranging from 60 to 382 pg/mL. Several studies have shown that presepsin is a valuable biomarker for sepsis diagnosis in adults. Only lately, presepsin has been evaluated for prediction and early detection of neonatal sepsis and septic shock. Elevated plasma presepsin concentration has also been reported in patients undergoing cardiac and non-cardiac surgery and it has further been evaluated as a potential independent predictor of perioperative cardiovascular complications and mortality. Combined cardiac and inflammatory biomarker evaluation may offer additive predictive information, but further investigations in large populations are required to determine presepsin diagnostic and prognostic value, in order to personalize therapy and reduce surgical patients' morbidity and mortality.

Analyses of interleukin-6, presepsin and pentraxin-3 in the diagnosis and severity of late-onset preeclampsia

Introduction The etiology/pathophysiology of preeclampsia remains an enigma. Maternal inflammation (humoral and cellular) is a key factor in the etiology of late-onset preeclampsia (L-PrE). Presepsin is split out from the phagocytes membranes after phagocytosis. It is known as a novel inflammation marker. To our knowledge, this is the first study in literature in English to investigate maternal blood concentrations of presepsin in preeclampsia and healthy pregnant women. Methods We examined maternal plasma interleukin-6, presepsin and pentraxin-3 concentrations in pregnant women with (n = 44) and without L-PrE (n = 44). These three inflammatory markers concentrations measured using enzyme-linked immunosorbent assays were compared. Results The mean maternal age and gestational age at sampling are similar in the both groups (p ≥ .05). Interleukin-6, presepsin and pentraxin-3 concentrations differed between the groups (p < .05). There was no difference between the three inflammatory markers concentrations in patients with mild (22 patients) and severe (22 patients) preeclampsia in L-PrE (p ≥ .05). A significant discriminative role of interleukin-6, presepsin and pentraxin-3 for presence of L-PrE, with cutoff values of 39.74 pg/mL, 309.88 mg/L and 34.96 ng/mL, respectively, were reported in a ROC curve analysis. When the patients with and without small for gestational age infants (12 patients and 76 patients, respectively) were compared, it was determined that there was no differences between the interleukin-6, but there were differences between the presepsin and pentraxin-3 concentrations (p = .016, p = .008, respectively). Conclusion Lower concentrations of interleukin-6/presepsin and higher concentrations of pentraxin-3 were associated with the development of preeclampsia. Further investigations of inflammatory/immunity markers in pregnancy are required and may ultimately lead to novel therapeutic approaches to treat complications of pregnancy.

Role of Plasma Presepsin, Procalcitonin and C-reactive Protein Levels in Determining the Severity and Mortality of Community-Acquired Pneumonia in the Emergency Department

Objective: In this study, we aimed to explore the role of the plasma presepsin level in patients with community-acquired pneumonia during admission to the emergency department in assessing the diagnosis, severity, and prognosis of the disease. In addition, we wanted to investigate the relationship of presepsinin with procalcitonin, C-reactive protein and pneumonia severity scores. Methods: One hundred twenty-three patients over the age of 18 who presented with a diagnosis of pneumonia to the emergency department were included in the study. The vital signs, symptoms, examination findings, background information, laboratory results, and radiological imaging results of the patients were recorded. The 30-day mortality rates of the patients were determined. Results: A statistically significant difference was found between the presepsin levels of the patients diagnosed with pneumonia and those of healthy subjects (p &lt; 0.05). The plasma presepsin levels of the patients who died (8.63 ± 6.46) were significantly higher than those of the patients who lived (5.82 ± 5.97) (p &lt; 0.05). The plasma procalcitonin and C-reactive protein levels of the dead patients were significantly higher than those living (p &lt; 0.05). A presepsin cut-off value of 3.3 ng/mL for 30-day mortality was established (AUROC, 0.65; specificity, 45%; sensitivity, 82%). Procalcitonin is the most successful biomarker in the determination of mortality (AUROC, 0.70). A significant correlation was available between presepsin and lactate, C-reactive protein and procalcitonin (p &lt; 0.05). There was a significant correlation between the Pneumonia Severity Index values and presepsin levels (p &lt; 0.001, r = 0.311). Conclusion: The plasma presepsin level can be utilized for diagnosing community-acquired pneumonia. Plasma presepsin, procalcitonin and C-reactive protein levels can be used to predict the severity and mortality of community-acquired pneumonia.

Utility of sTREM-1 and Presepsin (sCD14-ST) as Diagnostic and Prognostic Markers of Sepsis.

Sepsis is a condition prevalent among hospitalized patients which carries a high risk of morbidity and mortality. Rapid recognition of sepsis as the cause of deterioration is desirable, and then effective treatment can be initiated rapidly. Traditionally, diagnosis was based on the presence of two or more positive SIRS criteria due to infection. However, recently published sepsis-3 criteria put more emphasis on organ dysfunction caused by infection in the definition of sepsis. Regardless of this, no gold standard for diagnosis exists, and clinicians still rely on a number of traditional and novel biomarkers to discriminate between patients with and without infection, as the cause of deterioration. The present study aims to observe the changes of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and presepsin (sCD14-ST) 1evels in plasma of sepsis patients and explore the diagnosis and prognosis of sepsis. Sixty patients with sepsis admitted to the Department of Critical Care medicine in Hainan General Hospital from October 2013 to March 2019 were selected as the experimental group. Also chosen in the same period were 60 cases of hospitalized non-sepsis patients as a control group. Plasma levels of sTREM-1 and presepsin were determined by enzyme-linked immunosorbent assay (ELISA) in the 60 patients with sepsis and the 60 non-sepsis patients. Changes of sTREM-1 and presepsin plasma 1evels were observed in the survival subgroup and non-survival subgroup of the patients with sepsis on days 1, 4, 7, and the day of discharge or death. Plasma levels of sTREM-1 and presepsin in the patients with sepsis were higher than those in the control group on the day of admission (p < 0.01). The levels of sTREM-1 and presepsin in the septic shock group were significantly higher than those in the sepsis group (p < 0.01). Plasma levels of sTREM-1 and presepsin showed a decreasing trend in the survival subgroup of the patients with sepsis, while maintaining high 1evels or increased in the subgroup of non-survivors. At different time points, the plasma levels of sTREM-1 and presepsin of the subgroup of non-survivors were all significantly higher than the subgroup of survivors. There was a significant positive correlation between plasma 1evels of sTREM-1 and presepsin (r = 0.596, p < 0.01). According to the plasma sTREM-1, presepsin, CRP, and PCT levels on the first day of enrollment in patients with sepsis, ROC curve analysis was performed and AUC was calculated. The results showed that the AUC values of sTREM-1 and presepsin were relatively high, which was 0.925 and 0.910, respectively. The AUC of PCT and CRP were slightly lower, which was 0.861 and 0.816, respectively (p < 0.01). ROC curve was used to study the value of sTREM-1 and presepsin in the diagnosis of sepsis, which suggested that sTREM-1 and presepsin should be significantly superior to CRP and PCT levels. The sTREM-1 combined with presepsin had the highest AUC. sTREM-1 has been shown to have an optimal threshold of 125.00 pg/mL for the diagnosis of sepsis, the specificity was 86.0% and the sensitivity was 87.0%. Presepsin has been shown to have an optimal threshold of 1,025.00 pg/mL for the diagnosis of sepsis, the specificity was 83.0% and the sensitivity was 85.0%. The sTREM-1 and presepsin plasma levels have great reference value for the diagnosis of sepsis, and the sTREM-1 and presepsin plasma levels are relative to the severity of sepsis. It is helpful to evaluate treatment effect and prognosis of sepsis by dynamically monitoring the plasma 1evels of sTREM-1 and presepsin.

Diagnostic value of presepsin in predicting a complicated acute appendicitis

Aim: There is a growing body of evidence suggesting that the concentration of presepsin in serum was found to be increased in patients with sepsis compared to healthy individuals, but the clinical significance of presepsin in the diagnosis of complicated acute appendicitis remains unclear. The purpose of this study was investigation of the diagnostic value of presepsin in complicated acute appendicitis. Material and Methods: This clinical prospective single-center study was conducted between May and August 2018, and comprised 120 patients with definitive diagnosis of acute appendicitis and 30 individuals as control group. White blood cell count (WBC), C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR) and presepsin levels were measured from venous blood samples. A receiver operating characteristic (ROC) curve was constructed to assess sensitivity and specificity as well as optimal cut points for each presepsin to diagnose acute appendicitis.Results: Serum levels of CRP, WBC, NLR and presepsin were higher in complicated group compared with uncomplicated (p0.0001, p=0.01, p=0.034 and p0.0001, respectively). The time of hospitalization, the rate of postoperative infection, intraabdominal abscess and re-hospitalization were significantly higher in complicated group (p0.0001, p=0.0009, p=0.0073 and p=0.0073, respectively). Comparing the diagnostic test results with ROC analysis, variable WBC (AUC=0.646, p=0.0052), CRP (AUC=0.807, p0.001), NLR (AUC=0.620, p=0.0305) and presepsin (AUC=0.965, p0.001) were significant parameters in predicting the presence of complicated acute appendicitis. Cut-off points of CRP, WBC, NLR and presepsin were calculated as 13.5 mg/dL, 1.4 x103/uL, 4.79 and 272 pg/ml. AUC of presepsin was larger than AUCs of WBC, CRP and NLR, suggesting the highest predicting power of presepsin among other parameters.Conclusion: Plasma presepsin level with CRP, WBC and NLR are valuable diagnostic parameters to predict complicated acute appendicitis.

Usefulness of presepsin as diagnostic and prognostic marker of sepsis in daily clinical practice.

Sepsis represents a major cause of morbidity and mortality in critically ill patients. Early diagnosis and appropriate treatment have a crucial influence on survival. The aim of this study was to evaluate the diagnostic and prognostic role of presepsin (sCD14) in patients with sepsis. Fifty-four consecutive adult patients with sepsis and 26 patients with aseptic meningitis as a control group were included in this prospective observational study. In all patients included in the study, levels of C-reactive protein (CRP), presepsin, lactate, and a count of leukocytes and neutrophils were determined on admission. In those with suspected bacterial infection, two separate blood cultures were obtained and procalcitonin (PCT) concentration was detected. Plasma presepsin and PCT concentrations in septic group patients were followed on days 2, 3 and 7 after enrollment. The median presepsin serum concentration in patients with sepsis was 1614 pg/mL and in the control group it was 203 pg/mL (p < 0.001). Presepsin levels in patients with septic shock were higher than in sepsis patients (p < 0.014). The mean presepsin concentrations were higher in deceased than in surviving patients (p = 0.009). The trend of changes in presepsin concentrations in deceased patients was significantly different than in the surviving patients (p = 0.018). There were no statistically significant differences in the concentration of presepsin or other biomarkers in patients with Gram negative or Gram positive bacteria. Presepsin may be used as a diagnostic marker of systemic bacterial infection and can predict the severity and outcome of sepsis.

Prediction of presepsin concentrations through commensurate decline in kidney function in the elderly

BackgroundPresepsin is a useful biomarker to diagnose sepsis. However, the correlation between plasma presepsin concentrations and kidney function in the elderly with chronic kidney disease (CKD) remains to be elucidated. We determined whether plasma presepsin concentrations were influenced by kidney function decline in the elderly. MethodsOne hundred seventy outpatients with CKD aged ≥65 y were enrolled. Plasma presepsin concentrations were measured using immunoassay analysis. The relationship between plasma presepsin concentration and kidney function was assessed. ResultsThe median age of patients of this cohort was 778 (72–85) y and the mean estimated glomerular filtration rate was 51.8 ± 28.1 ml/min/1.73 m2. Plasma presepsin concentrations in those with CKD G4-G5 (362 pg/ml [273–553]) were significantly higher than in those with CKD G1-G2 (111 pg/ml [91–113]) and CKD G3 (145 pg/ml [124–205]) (p < 0.001, p < 0.001, respectively). A high correlation between plasma presepsin concentrations and kidney function was observed (R2 = 0.733, p < 0.001). Even after adjusting for confounders, plasma presepsin concentrations were independently associated with kidney function. ConclusionsIncreases in plasma presepsin concentrations were exponentially correlated to kidney function decline in the elderly with CKD.

P4620Circulating concentration of presepsin improves early prediction of short-term mortality in patients treated at medical cardiac intensive care units

Abstract Background Presepsin, a subtype of soluble CD14, is an inflammatory marker, which largely reflects monocytic activation. Presepsin appears to be an accurate diagnostic marker of sepsis, but its clinical significance remains unclear in cardiovascular disease. Purpose This prospective study aimed to investigate the predictive value of plasma presepsin levels on admission to medical (non-surgical) cardiac intensive care units (MCICUs) for short-term mortality. Methods We examined 1560 patients hospitalized in MCICUs and measured the baseline plasma presepsin levels at admission. Results Acute coronary syndrome was present in 46% of the patients, and acute decompensated heart failure in 36%. Before MCICUs admission, emergent coronary angiography or percutaneous coronary intervention was performed in 36%, mechanical ventilation was required for respiratory insufficiency in 2.1%, and intraaortic balloon pumps were needed for hemodynamic instability in 8.9%. During 6 months after admission, there were 113 (7.2%) deaths. Patients who died were older (median: 77 vs. 71 years, P&lt;0.0001); had higher levels of presepsin (263 vs. 119 pg/mL, P&lt;0.0001), B-type natriuretic peptide (BNP: 696 vs. 186 pg/mL, P&lt;0.0001), high-sensitivity troponin T (hsTnT: 81 vs. 47 pg/mL, P=0.004), and high-sensitivity C-reactive protein (13.8 vs. 2.2 mg/L, P&lt;0.0001); and had lower levels of estimated glomerular filtration rate (50 vs. 65 mL/min/1.73m2, P&lt;0.0001) and left ventricular ejection fraction (43% vs. 51%, P&lt;0.0001) than those of the survivors. In the multivariate Cox regression analysis, higher levels of presepsin (P=0.0002), BNP (P=0.04), and hsTnT (P=0.009) were all independent predictors of 6-month deaths. Quartiles of presepsin levels were associated with higher mortality rates within 6 months after admission (Table). Adding presepsin levels to a baseline model that included established risk factors, BNP, and hsTnT further enhanced reclassification (P=0.004) and discrimination (P=0.003) beyond that of the baseline model. Mortality rates according to presepsin Presepsin quartile 1st 2nd 3rd 4th P value ≤80 pg/mL 81–124 pg/mL 125–232 pg/mL &gt;232 pg/mL 1-month mortality 0.8% 2.0% 3.3% 8.0% &lt;0.0001 6-month mortality 0.8% 3.8% 8.2% 16.3% &lt;0.0001 Conclusions Presepsin levels at admission could improve the prediction of short-term mortality in patients hospitalized at MCICUs.

Plasma presepsin in determining gastric leaks following bariatric surgery

Abstract Background To be able to prevent morbid obesity in the long-term, laparoscopic sleeve gastrectomy (LSG) is one of the most effective surgical interventions. However, leakage and bleeding from the stapler line are significant complications. The aim of this study was to determine the role of the levels of plasma presepsin in the detection of stapler leakage. Materials and methods The study included 300 patients with LSG due to morbid obesity and 40 control subjects. Before any medical treatment was applied, blood samples were taken from patients at 12 h preoperatively and on days 1, 3, and 5 postoperatively. Evaluation was made of plasma presepsin levels, white blood count (WBC), C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR), in all patients with sleeve gastrectomy line leakage. Results The WBC, CRP, NLR and presepsin values measured on days 1, 3 and 5 postoperatively were determined to be higher in patients with leakage compared to those without. The predictive value of presepsin (p = 0.001), CRP (p = 0.001) and NLR (p = 0.001) was determined to be statistically significantly higher than that of WBC (p = 0.01). Conclusion The results of the study suggest that presepsin levels could have a role in the detection and follow-up of stapler line leaks after LSG. Elevated presepsin levels, on postoperative day 1 in particular, could have a key role in the early detection of possible complications which are not seen clinically.

Presepsin As a Biomarker for Evaluating Prognosis and Early Innate Immune Response of Out-of-Hospital Cardiac Arrest Patients After Return of Spontaneous Circulation.

After return of spontaneous circulation, patients who experienced out-of-hospital cardiac arrest present an impaired innate immune response that resembles sepsis. Presepsin, a new biomarker for sepsis, has not been studied in out-of-hospital cardiac arrest patients. This study explored the role of presepsin in evaluating the prognosis and early innate immune alteration of out-of-hospital cardiac arrest patients after return of spontaneous circulation by observing presepsin levels, CD14, and human leukocyte antigen-DR expression on monocytes. Retrospective analysis. The emergency department of an urban university tertiary hospital. One hundred sixty-five out-of-hospital cardiac arrest patients with return of spontaneous circulation more than 12 hours, and 100 healthy individuals. None. Plasma presepsin and procalcitonin levels were tested after resuscitation (day 0) and on days 1 and 3 after return of spontaneous circulation. Presepsin levels were higher in out-of-hospital cardiac arrest patients than in healthy individuals. In the first 3 days, presepsin and procalcitonin levels were persistently lower in 28-day survivors and patients with favorable neurologic outcome patients than in 28-day nonsurvivors and patients with unfavorable neurologic outcome. On days 0, 1, and 3, different cut-off values of presepsin showed prognostic value for 28-day mortality and favorable neurologic outcomes similar to procalcitonin. CD14 and human leukocyte antigen-DR expression on monocytes were analyzed by flow cytometry. Compared with controls, CD14 expression in out-of-hospital cardiac arrest patients increased on day 1 and began to decrease on day 3, whereas human leukocyte antigen-DR+ monocyte percentages decreased on days 1 and 3. Presepsin and procalcitonin had a low positive correlation with CD14 expression and a strong negative correlation with human leukocyte antigen-DR+ monocyte percentages on day 1. Plasma presepsin concentrations are independent prognostic factors for out-of-hospital cardiac arrest patients after return of spontaneous circulation and are correlated with abnormal CD14 and human leukocyte antigen-DR expression on monocytes. Monitoring presepsin levels may be helpful for evaluating the prognosis and impaired innate immune response in the early period after return of spontaneous circulation.

Impact of initial plasma presepsin level for clinical outcome in hospitalized patients with pneumonia.

Presepsin, the soluble CD14 subtype, is known as a sepsis biomarker. However, its clinical significance in pneumonia is unclear. We investigated the effects of plasma presepsin level on clinical outcomes in patients with pneumonia. Patients over 18 years old admitted to our hospital due to pneumonia from May 2016 through November 2017 were reviewed using electronic medical records. One hundred and seventy-two patients who underwent measurement of plasma presepsin levels on admission were enrolled. Median age of enrolled patients was 81 years [interquartile range (IQR), 68-86 years]. Pneumonia severity index (PSI) class and A-DROP score on admission were calculated. The receiver operating characteristic (ROC) curve analysis was performed to assess the prognostic value of 30-day mortality and to identify the optimal cut-off value of plasma presepsin level. Correlations between plasma presepsin level and other factors were assessed using the Spearman's test. The Kaplan-Meier survival analysis and the log-rank test were performed to assess the two curves differentiated with the optimal cut-off value of plasma presepsin level. Seventeen patients (9.9%) died within 30 days of admission. The deceased patients had higher value of plasma presepsin on admission (539 pg/mL; IQR, 414-832 pg/mL) compared with the survivors (334 pg/mL; IQR, 223-484 pg/mL) (P=0.001). The areas under ROC curve for predicting 30-day mortality were 0.742 for plasma presepsin, 0.755 for A-DROP score, and 0.774 for PSI class. Plasma presepsin level was not associated with etiology of pneumonia. However, it was moderately correlated with serum creatinine level (rs =0.524, P<0.001). The ROC curve analysis derived 470 pg/mL of plasma presepsin level as the optimal cut-off value for predicting 30-day mortality. The Kaplan-Meier survival analysis showed that patients with plasma presepsin level ≥470 pg/mL on admission had significantly higher 30-day mortality than those with plasma presepsin level <470 pg/mL (P<0.001). Among patients with A-DROP score ≥3, those with plasma presepsin level ≥470 mg on admission had significantly higher 30-day mortality (P=0.013). Similarly, among patients with PSI class ≥4, those with plasma presepsin level ≥470 mg on admission had significantly higher 30-day mortality (P=0.005). In hospitalized pneumonia patients, plasma presepsin level on admission could be a useful predictor of 30-day mortality and an additional prognostic biomarker on existing severity assessment scales.

P6252Preoperative plasma presepsin predicts major adverse cardiac and cerebrovascular complications after elective, non-cardiac surgery - post-hoc analysis from the LeukoCAPE-2 trial

P6252Preoperative plasma presepsin predicts major adverse cardiac and cerebrovascular complications after elective, non-cardiac surgery - post-hoc analysis from the LeukoCAPE-2 trial

Serum Presepsin Levels in Patients with Decompensated Heart Failure

Objective: Recently, the soluble CD14 subtype; presepsin (PSP) has been suggested as a reliable marker for systemic inflammation, which has not been studied in decompensated heart failure (DHF) up to date. Our aim was to investigate plasma PSP levels and its diagnostic ability in patients with DHF. Methods: Fifty patients with DHF and 51 controls without HF were included in our study. Besides routine clinical and laboratory data, N-terminal prohormone of brain natriuretic peptide (NT-pro BNP) and PSP levels were measured in blood samples of all the participants. Results: PSP levels were significantly higher in patients with DHF than controls (1107.98 ± 1001.15 vs. 540.47 ± 526.9 pg / mL, p = 0.001). Cut-off value for PSP was 442 pg / mL to detect HF with 76% sensitivity, 62.7% specificity, 66.7% positive predictive value and 72.7% negative predictive value (CI: 0.975 – 1.000). The diagnostic accuracy of PSP for DHF was not superior to that of NT-pro BNP (AUC: 0.99 vs. 0.74) Conclusions: This preliminary study reveals that PSP levels are significantly elevated in patients with DHF but the diagnostic power of PSP for DHF is lower than NT-pro BNP. PSP may be a new marker for DHF.

Presepsin and Inflammatory Markers Correlate With Occurrence and Severity of Nonocclusive Mesenteric Ischemia After Cardiovascular Surgery.

To prospectively evaluate the relationship of established inflammatory markers and presepsin on nonocclusive mesenteric ischemia and to correlate presepsin levels to the occurrence and severity of nonocclusive mesenteric ischemia. Patients were prospectively enrolled and blood samples taken, followed by a retrospective evaluation of laboratory values and angiographic findings. The study was ethics committee approved. Patients with clinical suspicion of nonocclusive mesenteric ischemia underwent catheter angiography of the superior mesenteric artery. Images were assessed by two experienced radiologists on consensus basis using a previously published standardized reporting system (Homburg-Nonocclusive Mesenteric Ischemia-Score). Two groups were formed according to the severity of nonocclusive mesenteric ischemia, mild and severe, patients without clinical signs of nonocclusive mesenteric ischemia formed the reference group. These data were correlated to inflammatory blood markers assessed pre- and postoperatively: C-reactive protein, leucocytes, procalcitonin, and presepsin as well as outcome data. Between January 2010 and March 2011, a total of 839 patients undergoing cardiovascular surgery participated in this study. Mild nonocclusive mesenteric ischemia was diagnosed in 4.5%, and severe nonocclusive mesenteric ischemia in 3.2%. Median postoperative presepsin concentrations were significantly greater in mild and severe nonocclusive mesenteric ischemia than in non-nonocclusive mesenteric ischemia. Statistics showed that postoperative presepsin better discriminated mild and severe nonocclusive mesenteric ischemia than any other tested biomarker. Elevated postoperative plasma presepsin concentrations are an independent predictor of mild and severe nonocclusive mesenteric ischemia. The established inflammatory blood markers significantly correlate with the development and severity of nonocclusive mesenteric ischemia.

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

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.

Presepsin levels in cirrhotic patients with bacterial infections and/or portal hypertension-related bleeding, presenting with or without acute kidney injury.

BackgroundBacterial infections in cirrhotic patients remain a challenge. Presepsin has been proposed as a valuable sepsis biomarker. We aimed to assess plasma presepsin levels in uncomplicated cirrhotic patients and to correlate them with liver disease severity and complicating events, defined as documented bacterial infection with or without concomitant portal hypertension-related bleeding, or bleeding without documented bacterial infection, with or without acute kidney injury.MethodsWe prospectively evaluated the presepsin levels of 108 consecutive uncomplicated cirrhotic patients with compensated (55, 50.9%) or decompensated (53, 49.1%) cirrhosis. During the follow up, 20 patients were reevaluated for a complicating event.ResultsMean baseline presepsin levels of the entire population were 440.4 pg/mL. Patients with decompensated cirrhosis exhibited significantly higher baseline levels than patients with compensated cirrhosis (599.1±492.2 vs. 287.5±130.5 pg/mL, P<0.001). In complicated cirrhotic patients, admission levels were remarkably higher than baseline (1438.0±1247.2 vs. 725.3±602.8 pg/mL, P<0.001), especially in those who developed acute kidney injury compared to those who did not (1827.3±1118.8 vs. 1048.7±1302.1 pg/mL, P<0.05). Baseline presepsin levels, using a cutoff of 607.5 pg/mL, could predict liver disease-related 3-month mortality with 77.8% sensitivity and 86.9% specificity: area under the receiver operating characteristic curve 0.825; 95% confidence interval 0.684-0.967; P<0.01.ConclusionsPlasma presepsin levels are elevated in uncomplicated cirrhotic patients, especially in those with advanced liver disease, and rise further in those complicated by an event. Baseline presepsin levels in cirrhotic patients could be used as an additional marker, along with the model for end-stage liver disease score, to predict short-term outcomes.

The Physiological Variation in Plasma Presepsin Levels During the Early Neonatal Period.

Neonatal sepsis continues to be a global problem with significant morbidity and mortality, because of the difficulty in predicting its onset with clinical symptoms alone. Thus, the presence of biomarkers is useful for the diagnosis of neonatal sepsis. Presepsin is a 13-kDa truncated form of soluble CD14 that is produced through proteolytic cleavage on activated monocytes. Presepsin, consisting of 64 amino acid residues, has been proposed as a reliable biomarker for the early diagnosis of sepsis in neonates. However, some biomarkers for the diagnosis of sepsis are elevated during the early neonatal period due to physiological variation, whereas such variation in presepsin levels is uncertain. The objective of this study is to investigate the physiological variation in plasma presepsin levels during the early neonatal period. This prospective study included 30 full-term healthy neonates, including 15 neonates delivered by cesarean section. Plasma presepsin levels were examined at birth and on the first day and the fifth day of life in neonates, and the levels on the 5th day of life were lower than those at any other points (P < 0.001). Moreover, there was no significant difference of plasma presepsin levels between neonates delivered vaginally and by cesarean section. The physiological variation in plasma presepsin levels was observed during the early neonatal period. Attention needs to be paid when measuring plasma presespsin levels for the screening of sepsis during the early neonatal period.

Presepsin as a novel diagnostic biomarker for differentiating active pulmonary tuberculosis from bacterial community acquired pneumonia

BackgroundThe expression of presepsin in active pulmonary tuberculosis (APTB) is unknown. We observed the expression of presepsin in APTB, and to evaluate the value for discriminating between APTB and bacterial community acquired pneumonia (BCAP). MethodsConsecutive APTB patients who were accurately diagnosed by sputum culture and BCAP patients were enrolled from August 2013 to July 2015. Clinical data were collected, and plasma presepsin concentrations were tested. Receiver operating characteristic (ROC) curves were performed for diagnostic analysis. ResultsIn all, 133 healthy individuals, 103 APTB and 202 BCAP patients were enrolled. Presepsin concentrations in APTB group (218.0 [146.0, 368.0] pg/ml) were higher than those in the healthy control group (128.0 [101.5, 176.5] pg/ml, P<0.001), and lower than the concentrations measured in the BCAP group (532.0 [364.0, 852.3] pg/ml, P<0.001). Simple APTB and miliary tuberculosis patients showed no significant differences in presepsin concentrations. Compared with both Gram-positive and negative bacteria, Mycobacterium tuberculosis caused a limited increase of presepsin. With the cut-off value set at 401pg/ml, presepsin demonstrated high positive predictive value, allowing initial discriminating between APTB and BCAP. Presepsin combined with CURB-65 score could significantly improve the discrimination ability. ConclusionsPresepsin concentrations in APTB patients were slightly increased, and may be helpful for initial discrimination between APTB and BCAP.

The utility of presepsin in diagnosis and risk stratification for the emergency patients with sepsis

ObjectivesTo evaluate the value of presepsin in diagnosis and risk stratification of septic patients in emergency department, and investigate the utility in differentiation of gram-positive and gram-negative bacterial infection. MethodsWe enrolled 72 patients with sepsis and 23 nonbacterial patients with systemic inflammatory response syndrome (SIRS) who were admitted to the emergency department of Tianjin Medical University General Hospital. Meanwhile, 20 healthy volunteers were included. Plasma presepsin, serum PCT, C-reactive protein (CRP), lactate and white blood cells (WBC) were measured, and APACHE II score were calculated upon admission. The receiver-operating-characteristic curve (ROC) was computed and the area under the ROC curve was for evaluating the value to diagnose sepsis. Then the patients were grouped according to the result of culture and severity of sepsis. ResultsThe levels of presepsin, PCT, CRP and WBC were apparently higher in sepsis patients than in nonbacterial SIRS group (P<0.05). The levels of presepsin and the APACHEII score were demonstrated the significant difference among sepsis, severe sepsis and septic shock patients (P<0.05). The area under the ROC curve of presepsin, PCT, CRP and WBC were 0.954, 0.874, 0.859 and 0.723 respectively. The cutoff of presepsin for discrimination of sepsis and nonbacterial infectious SIRS was determined to be 407pg/ml, of which the clinical sensitivity and specificity were 98.6% and 82.6%, respectively. Moreover, presepsin was significantly different between gram-positive and gram-negative bacterial infection (P<0.05). ConclusionPresepsin was a promising biomarker for initially diagnosis and risk stratification of sepsis, and a potential marker to distinguish gram-positive and gram-negative bacterial infection.

Clinical significance of plasma presepsin levels in patients with systemic lupus erythematosus

Objectives: Presepsin (PSEP: soluble CD14 subtype) is produced from bacteria-stimulated monocytes or neutrophils, thus recognized as a biomarker of sepsis. Aberrant functions in monocyte or neutrophils are increasingly recognized in systemic lupus erythematosus (SLE). We investigated whether plasma PSEP reflects disease activity in patients with SLE.Methods: This retrospective study comprised 35 patients with SLE and 72 with non-SLE autoimmune diseases who visited our facility during the period from August 2012 to September 2015. Plasma PSEP levels and laboratory data were compared between SLE and non-SLE. Clinical markers of SLE disease activity, including SLE disease activity index 2000 (SLEDAI-2K), serum complement concentrations and serum anti-ds-DNA antibodies were assessed in correlation with plasma PSEP levels.Results: Plasma PSEP levels in SLE were higher than those in non-SLE. This phenomenon holds true when comparing SLE and non-SLE patients in the absence of infection (p = .0008). Plasma PSEP levels in SLE patients negatively correlated with C3 (r = –0.4454, p = .0430), CH50 (r = –0.4502, p = .0406) and positively with SLEDAI-2K (r = 0.4801, p = .0237).Conclusion: Elevated plasma PSEP levels were correlated with disease activity of SLE, suggesting inappropriate monocyte or neutrophil activation in the pathophysiology of SLE exacerbation.