Presepsin Levels Research Articles

ENHANCED EFFICACY OF RESVERATROL-LOADED SILVER NANOPARTICLE IN ATTENUATING SEPSIS-INDUCED ACUTE LIVER INJURY: MODULATION OF INFLAMMATION, OXIDATIVE STRESS, AND SIRT1 ACTIVATION.

Sepsis-induced acute liver injury is a life-threatening condition involving inflammation, oxidative stress, and endothelial dysfunction. In the present study, the preventive effects of resveratrol (RV) alone and RV-loaded silver nanoparticles (AgNPs + RV) against sepsis-induced damage were investigated and compared in a rat model of polymicrobial sepsis induced by cecal ligation and puncture (CLP). Rats were divided into four groups: Sham, CLP, RV, and AgNPs + RV. Pro-inflammatory cytokines (TNF-α, IL-1β, IL-6), nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) activation, presepsin, procalcitonin (PCT), 8-hydroxy-2'-deoxyguanosine (8-OHDG), vascular endothelial growth factor (VEGF), and sirtuin-1 (SIRT1) levels were assessed to determine the treatments' effects. AgNPs + RV treatment significantly reduced pro-inflammatory cytokines, NF-κB activation, presepsin, PCT, 8-OHDG, and VEGF levels compared with the CLP group, indicating attenuation of sepsis-induced liver injury. Both RV and AgNPs + RV treatments increased SIRT1 levels, suggesting a potential role of SIRT1 activation in mediating the protective effects. In conclusion, AgNPs + RV treatment demonstrated extremely enhanced efficacy in alleviating sepsis-induced liver injury by modulating inflammation, oxidative stress, and endothelial dysfunction, potentially mediated through SIRT1 activation. In this study, the effect of AgNPs + RV on sepsis was evaluated for the first time, and these findings highlight AgNPs + RV as a promising therapeutic strategy for managing sepsis-induced liver injury, warranting further investigation.

The value of plasma presepsin as a diagnostic and prognostic biomarker for sepsis in Southern China.

Presepsin is a soluble CD14 subtype that has been considered as a novel marker for patients with sepsis.This study explored the clinical value of presepsin for sepsis in Southern China, and further established models for diagnosis and prognosis of sepsis through using machine learning (ML), by combining presepsin and other laboratory parameters. 269 subjects (105 infected patients, 164 sepsis and septic shock) and 198 healthy controls were enrolled. Laboratory parameters (hematological parameters, coagulation parameters, liver function indices, renal function indices, and inflammatory markers) were collected. Plasma presepsin was tested by chemiluminescence enzyme immunoassay. ML of DxAI™ Research platform was used to establish diagnostic and prognostic models. Sensitivity, specificity, and other performance indicators were used to evaluate the performance of each model. The level of presepsin was obviously increased in sepsis and sepsis shock, compared with that of infected and healthy group (all P < 0.0001). Presepsin concentration was positively correlated with positive blood culture and 30-day mortality in sepsis and septic shock patients. Through ROC curve analysis, Hb, UREA, APTT, CRP, PCT, and presepsin were incorporated into machine learning to construct diagnosis models. Ada Boost model had the best diagnostic efficiency (AUC: 0.94 (95% CI 0.919-0.968) in the training set and AUC: 0.86 (95% CI 0.813-0.900) in validation set). Furthermore, AST, APTT, UREA, PCT, and presepsin were included in the prognosis ML models, and the Bernoulli NB model had greater predictive ability for 30-day mortality risk of sepsis (AUC: 0.706), which was higher than that of PCT (AUC: 0.617) and presepsin (AUC: 0.634) alone. Machine-learning model based on presepsin and routinely laboratory parameters showed good performance of diagnostic and prognostic ability for sepsis patients.

Diagnostic Evaluation of Modified Hematological Sepsis Score and Presepsin in Neonatal Sepsis

Abstract Background Early diagnosis of neonatal sepsis and assessment of the severity of the disease is not yet effectively achieved. Some hematological parameters are used to formulate a hematological scoring system (HSS) and a modified hematological scoring system(MHSS), for diagnosis of neonatal sepsis. A promising biomarker is Presepsin, or Soluble Cluster of Differentiation 14 SubType (sCD14-ST), which is a proteolysis product of CD14, that is produced after immune activation during infections. Aim of the Work To evaluate the performance of both HSS, MHSS and serum presepsin level, in neonatal sepsis, and compare them to C-reactive protein (CRP) as diagnostic tools and predictors of mortality. Methods The study was divided into two groups, one group comprised 51 neonates who further subgrouped into suspected &amp; proved sepsis, along with 30 neonates who were admitted for non-infectious causes who served as control group. Both groups were subjected to calculation of HSS, MHSS, serum presepsin levels, CRP measurement, blood culture and, assessed for clinical severity and mortality. Results Hematological sepsis scores and presepsin levels were significantly higher in sepsis group. Presepsin showed the best diagnostic performance at &amp;gt; 0.5 ng/ml (AUC 0.979; sensitivity of 94.1% and specificity of 100%). While HSS and MHSS at a cutoff value &amp;gt; 1 achieved comparable specificity but lower sensitivity, 72.6% for the former and 76.5% for the later. Presepsin also was significantly higher in died group with the best predictive performance over CRP at cut-off value &amp;gt;1.9 ng/ml (AUC 0.83; sensitivity of 85.7% and specificity of 79.6%) Conclusions Hematological sepsis scores and presepsin were found to be useful diagnostic tools in neonatal sepsis with presepsin as a good predictor of mortality comparable to CRP. Disclosure: The authors declare that they have no conflict of interest.

Could Zonulin and Presepsin Be Biomarkers and Therapeutic Targets for Acute Myocarditis?

The diagnosis of acute myocarditis is usually made with clinical and laboratory parameters. This can sometimes be mixed up with diseases that have similar clinical features, making the diagnosis difficult. Therefore, the use of more specific biomarkers, in addition to the classically used biomarkers such as troponin, will accelerate the diagnosis. In addition, these biomarkers may help us to understand the mechanism of myocarditis development and thus predict unpredictable clinical outcomes. This study aims to reveal the possible relationship between intestinal permeability and acute myocarditis. In this study, we wanted to evaluate serum levels of zonulin and presepsin in 138 consecutive subjects, including 68 patients with myocarditis and another 70 as the control group, matched for age, gender, and cardiovascular risk factors. P-values <0.05 were considered to be statistically significant. Compared to the control group, zonulin and presepsin were significantly higher in the patient group with myocarditis (p < 0.001, for all). Zonulin levels were positively correlated with presepsin, peak CK-MB, and peak troponin levels (r = 0.461, p < 0.001; r = 0.744, p < 0.001; r = 0.627, p < 0.001; respectively). In regression analysis, presepsin and zonulin were determined as independent predictors for myocarditis (OR 1.002, 95% CI 1.001-1.003, p = 0.025; OR 12.331, 95% CI 4.261-35.689; p < 0.001; respectively). The predictive value of acute myocarditis of presepsin and zonulin in ROC curve analysis was statistically significant (p < 0.001, for both). This study showed that zonulin and presepsin could be biomarkers that can be used in the diagnosis of myocarditis, and they can also be therapeutic targets by shedding light on the developmental mechanism of myocarditis.

Utility of Presepsin and Interferon-λ3 for Predicting Disease Severity and Clinical Outcomes in COVID-19 Patients.

We explored the utility of novel biomarkers, presepsin and interferon-λ3 (IFN-λ3), for predicting disease severity and clinical outcomes in hospitalized Coronavirus (COVID-19) patients. In a total of 55 patients (non-critical, n = 16; critical, n = 39), presepsin and IFN-λ3 were compared with sequential organ failure assessment (SOFA) scores and age. Disease severity and clinical outcomes (in-hospital mortality, intensive care unit admission, ventilator use, and kidney replacement therapy) were analyzed using receiver operating characteristic (ROC) curves. In-hospital mortality was also analyzed using the Kaplan-Meier method with hazard ratios (HR). SOFA scores, age, presepsin, and IFN-λ3 predicted disease severity comparably (area under the curve [AUC], 0.67-0.73). SOFA score and IFN-λ3 predicted clinical outcomes comparably (AUC, 0.68-0.88 and 0.66-0.74, respectively). Presepsin predicted in-hospital mortality (AUC = 0.74). The combination of presepsin and IFN-λ3 showed a higher mortality risk than SOFA score or age (HR [95% confidence interval, CI], 6.7 [1.8-24.1]; 3.6 [1.1-12.1]; 2.8 [0.8-9.6], respectively) and mortality rate further increased when presepsin and IFN-λ3 were added to SOFA scores or age (8.5 [6.8-24.6], 4.2 [0.9-20.6], respectively). In the elderly (≥65 years), in-hospital mortality rate was significantly higher when both presepsin and IFN-λ3 levels increased than when either one or no biomarker level increased (88.9% vs. 14.3%, p < 0.001). Presepsin and IFN-λ3 predicted disease severity and clinical outcomes in hospitalized COVID-19 patients. Both biomarkers, whether alone or added to the clinical assessment, could be useful for managing COVID-19 patients, especially the elderly.

#3252 PRESEPSIN AS A POTENTIAL BIOMARKER FOR RENAL INVOLVEMENT IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Abstract Background and Aims Presepsin is a soluble CD14 subtype known as a sepsis biomarker. Recently, it has been reported to correlate with kidney function decline in elderly patients with chronic kidney disease and to predict acute kidney injury in patients with sepsis. However, the potential role of presepsin in systemic lupus erythematosus (SLE) with kidney involvement is still unclear. This study aimed to evaluate the relationship between serum presepsin level and SLE disease activity and laboratory parameters and to validate presepsin as a biomarker for lupus nephritis (LN). Method This cross-sectional study included 78 SLE patients aged 38.9±12.8 years. Among them, there were 68 (87.2%) women, 36 (46.2%) patients with LN, and 42 (53.8%) patients without LN. LN was diagnosed by renal biopsy and/or according to the renal SLE disease activity index (SLEDAI) criteria. Patients with infections were not included in the study. Serum presepsin level was determined by ELISA. The diagnostic value of presepsin level for the detection of LN was assessed by receiver-operating characteristic curves (ROC), the area under the curve (AUC), and 95% confidence intervals (CI). Spearman and Pearson correlation tests were performed to evaluate the relationships between presepsin level and SLEDAI score, serum complement concentrations, anti-double-stranded DNA antibodies (anti-dsDNA), inflammatory markers, urinary protein, and estimated glomerular filtration rate (eGFR) with CKD-EPI. Results The median serum presepsin level was significantly higher in patients with LN than in those without kidney damage [145 (110-197) pg/ml vs 102 (82-146) pg/ml, p = 0.011]. The ROC analysis found that the most appropriate cut-off point for presepsin concentration as a biomarker for LN in LSE patients was 106 pg/ml with a sensitivity of 81.8% (95% CI 64.5-93.0), and specificity of 54.3% (95% CI 36.6-71.2). The AUC was 0.714 (95% CI 0.592-0.837) with a positive predictive value of 62.8% (95% CI 46.7-77.0), and a negative predictive value of 76.0% (95% CI 54.9-90.6) (Fig. 1). The mean value of eGFR was 83.8±27.0 ml/min/1.73 m2 in the LN group and 94.1±18.0 ml/min/1.73 m2 in the non-LN group (p = 0.112). A significant negative correlation was observed between presepsin levels and eGFR in LN patients (Fig. 2). Moreover, presepsin levels in the LN group significantly correlated with SLEDAI score (r = 0.372, p = 0.036), anti-dsDNA titer (r = 0.363, p = 0.04) and severity of proteinuria (r = 0.630, p&amp;lt;0.01). No such associations were found in SLE patients without kidney involvement. Presepsin concentration did not correlate with C3, C4, C-reactive protein, erythrocyte sedimentation rate, and procalcitonin levels in both groups. Conclusion Serum presepsin may be considered a potential biomarker for the detection of kidney damage in patients with SLE. Further studies focusing on the clinical and pathological associations of presepsin in LN would be of interest.

Predictive value of cell population data with Sysmex XN-series hematology analyzer for culture-proven bacteremia.

Cell population data (CPD) parameters related to neutrophils, such as fluorescent light intensity (NE-SFL) and fluorescent light distribution width index (NE-WY), have emerged as potential biomarkers for sepsis. However, the diagnostic implication in acute bacterial infection remains unclear. This study assessed the diagnostic value of NE-WY and NE-SFL for bacteremia in patients with acute bacterial infections, and those associations with other sepsis biomarkers. Patients with acute bacterial infections were enrolled in this prospective observational cohort study. For all patients, a blood sample, with at least two sets of blood cultures, were collected at the onset of infection. Microbiological evaluation included examination of the blood bacterial load using PCR. CPD was assessed using Automated Hematology analyzer Sysmex series XN-2000. Serum levels of procalcitonin (PCT), interleukin-6 (IL-6), presepsin, and CRP were also assessed. Of 93 patients with acute bacterial infection, 24 developed culture-proven bacteremia and 69 did not. NE-SFL and NE-WY were significantly higher in patients with bacteremia than in those without bacteremia (p < 0.005, respectively), and were significantly correlated with the bacterial load determined by PCR (r = 0.384 and r = 0.374, p < 0.005, respectively). To assess the diagnostic value for bacteremia, receiver operating characteristic curve analysis was used. NE-SFL and NE-WY showed an area under the curve of 0.685 and 0.708, respectively, while those of PCT, IL-6, presepsin, and CRP were 0.744, 0.778, 0.685, and 0.528, respectively. Correlation analysis showed that the levels of NE-WY and NE-SFL were strongly correlated with PCT and IL-6 levels. This study demonstrated that NE-WY and NE-SFL could predict bacteremia in a manner that may be different from that of other indicators. These findings suggest there are potential benefits of NE-WY/NE-SFL in predicting severe bacterial infections.

TOP-049 - Increased level of presepsin in patients with acutely decompensated cirrhosis predicts development of acute-on-chronic liver failure

TOP-049 - Increased level of presepsin in patients with acutely decompensated cirrhosis predicts development of acute-on-chronic liver failure

Utility of urinary presepsin in the diagnosis of pyelonephritis: a cross-sectional study

BackgroundPresepsin is produced during the phagocytosis of bacteria by granulocytes. Presepsin increases at the site of infection; however, the significance of urinary presepsin in pyelonephritis is unknown. This study aimed to evaluate whether measuring urinary presepsin can distinguish between pyelonephritis and nonpyelonephritis.MethodsA cross-sectional study of patients with suspected pyelonephritis was conducted. Urinary presepsin at admission was compared between the pyelonephritis and nonpyelonephritis groups using the Mann–Whitney test. The predictive accuracy of urinary presepsin for diagnosing pyelonephritis was evaluated by the area under the receiver operating characteristics (ROC) analysis curve.ResultsA total of 35 eligible participants were included in the pyelonephritis group and 25 in the nonpyelonephritis group. The median urinary presepsin level was 2232.0 (interquartile range [IQR], 1029.0–3907.0) pg/mL in the pyelonephritis group and 1348.0 (IQR, 614.5–2304.8) pg/mL in the nonpyelonephritis group. Urinary presepsin concentrations were significantly higher in the pyelonephritis group than in the nonpyelonephritis group (P = 0.023). ROC analysis of urinary presepsin revealed a cutoff value of 3650 pg/mL to distinguish between the pyelonephritis and nonpyelonephritis groups. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio for the diagnosis of pyelonephritis were 0.40 (95% confidence interval [CI], 0.24–0.58), 0.96 (95% CI, 0.79–1.00), 0.93 (95% CI, 0.68–1.00), 0.52 (95% CI, 0.37–0.68), 9.60 (95% CI, 1.35–68.23), and 0.62 (95% CI, 0.47–0.83), respectively.ConclusionsThe measurement of urinary presepsin is useful in differentiating pyelonephritis from other diseases.

Assessing the significance of some biomarkers in perioperative period after thoracic aortic reconstruction

Aim. This study aims to assess the association between levels of biomarkers and postoperative complications in patients after thoracic and thoracoabdominal aortic reconstruction.Material and methods. This study included 132 patients. The most of them underwent ascending aortic and aortic arch reconstruction (65 and 57, respectively).The concentrations of proadrenomedullin, presepsin, procalcitonin, troponin I and N-terminal brain natriuretic peptide were measured before induction anesthesia, at the end of the surgical operation and in 6 hours after surgery.Results. 69 patients had postoperative complications. Among them, inflammatory (27,3%) and cardiovascular complications (12,1%) prevailed. At the end of the surgical operation, the levels of the biomarkers in patients without postoperative complications and with postoperative complications were for presepsin 326 [206; 451] и 620 [332; 829] p&lt;0,00001, tropononin I 0,77 [0,46; 1,39] and 1,49 [0,59; 3,39], p=0,01, proadrenomedullin 0,894 [0,683; 1,221] and 1,201 [0,944; 1,762], p=0,0002, procalcitonin 0,206 [0,147; 0,452] and 0,563 [0,307; 2,107], p=0,0002, respectively. According to log-linear regression model, the level of prepepsin at the end of the surgical operation &gt;459,5 (odds ratio (OR) 6,84, 95% confidence interval (CI): 3,14-14,87) or proadrenomedullin &gt;0,788 (OR 5,47, 95% CI: 1,52-19,68) are associated with the increased risk of postoperative complications. The level of presepsin &gt;519,5 pg/ml at the end of the surgical operation (OR 4,55, 95% CI: 1,97-10,47) is associated with the increased risk of inflammatory complications. Regarding the prognosis of the risk of prolonged cardiotonic drug infusions, threshold values for troponin were &gt;1,04 at the end of the surgical operation (sensitivity 75%, specificity 71,3%, AUC 0,785), &gt;1,57 in 6 hours after surgery (sensitivity 81,3%, specificity 71,6%, AUC 0,794).Conclusion. High levels of presepsin at the end of the surgical operation may be useful to predict the postoperative complications in patients who underwent the aortic surgery however, the low levels of presepsin do not exclude the development of postoperative complications. The increased level of troponin I at the end of the surgical operation and in 6 hours after surgery can be a predictor of the need for cardiotonic support in the postoperative period.

Presepsin: gelsolin ratio, as a promising marker of sepsis-related organ dysfunction: a prospective observational study.

We aimed to facilitate the diagnosis and prognosis of sepsis-related organ dysfunction through analyzing presepsin (PSEP) and gelsolin (GSN) levels along with a novel marker, the presepsin:gelsolin (PSEP:GSN) ratio. Blood samples were collected from septic patients at the intensive care unit (ICU) at three time points (T1-3): T1: within 12 h after admission; T2: second day morning; T3: third day morning. Sampling points for non-septic ICU patients were T1 and T3. PSEP was measured by a chemiluminescence-based POCT method while GSN was determined by an automated immune turbidimetric assay. Data were compared with routine lab and clinical parameters. Patients were categorized by the Sepsis-3 definitions. PSEP:GSN ratio was evaluated in major sepsis-related organ dysfunctions including hemodynamic instability, respiratory insufficiency and acute kidney injury (AKI). In our single center prospective observational study, 126 patients were enrolled (23 control, 38 non-septic and 65 septic patients). In contrast to controls, significantly elevated (p < 0.001) admission PSEP:GSN ratios were found in non-septic and septic patients. Regarding 10-day mortality prediction, PSEP:GSN ratios were lower (p < 0.05) in survivors than in non-survivors during follow-up, while the prognostic performance of PSEP:GSN ratio was similar to widely used clinical scores (APACHE II, SAPS II, SOFA). PSEP:GSN ratios were also higher (p < 0.001) in patients with sepsis-related AKI than septic non-AKI patients during follow-up, especially in sepsis-related AKI patients needing renal replacement therapy. Furthermore, increasing PSEP:GSN ratios were in good agreement (p < 0.001) with the dosage and the duration of vasopressor requirement in septic patients. Moreover, PSEP:GSN ratios were markedly greater (p < 0.001) in patients with septic shock than in septic patients without shock. Compared to septic patients requiring oxygen supplementation, substantially elevated (p < 0.001) PSEP:GSN ratios were observed in septic patients with demand for mechanical ventilation, while higher PSEP:GSN ratios (p < 0.001) were also associated with extended periods of mechanical ventilation requirement in septic patients. PSEP:GSN ratio could be a useful complementary marker besides the routinely used SOFA score regarding the diagnosis and short term mortality prediction of sepsis. Furthermore, the significant increase of this biomarker may also indicate the need for prolonged vasopressor or mechanical ventilation requirement of septic patients. PSEP:GSN ratio could yield valuable information regarding the extent of inflammation and the simultaneous depletion of the patient's scavenger capacity during sepsis. NIH U.S. National Library of Medicine, ClinicalTrails.gov. Trial identifier: NCT05060679, (https://clinicaltrials.gov/ct2/show/NCT05060679) 23.03.2022, Retrospectively registered.

Presepsin Levels and Neutrophil-to-Lymphocyte Ratio are Positively Correlated with Procalcitonin Levels in Early Onset Neonatal Sepsis

BACKGROUND: Early-onset neonatal sepsis (EONS) is an acute infection and sepsis occurring within the first 24 hours of new-born life. An increase in procalcitonin levels, presepsin levels, and neutrophil-to-lymphocyte ratio (NLR) in EONS subjects have been reported. However, whether presepsin levels and NLR affect the procalcitonin levels in EONS patients who have received antibiotic therapy has not been certainly known. This study was conducted to determine the correlation between presepsin levels and NLR with procalcitonin levels in EONS subjects.METHODS: A cross-sectional study involving 52 EONS subjects were conducted, and blood samples from subjects were collected. Presepsin levels were examined by enzyme-linked immunosorbent assay (ELISA) method, NLR was calculated from the absolute number of neutrophils divided by the absolute number of lymphocytes, and procalcitonin levels were examined by chemiluminescent microparticle immunoassay (CMIA) method. RESULTS: Median of procalcitonin levels and presepsin levels were 0.435 (0.12-9.11) ng/mL and 108.33 (71.43-1287.76) ng/L, respectively. While NLR value was 1.68 (0.2-7.52). There was significant difference between procalcitonin and presepsin levels (p=0.000), and so does between procalcitonin levels and NLR (p=0.001). Based on the multivariate analysis, presepsin levels also affected the procalcitonin levels (p=0.000; 95% CI: 0.001-0.004).CONCLUSION: The results of the study showed that there was significant correlation between presepsin levels and NLR with procalcitonin levels in EONS patients, suggesting that presepsin levels, NLR, and procalcitonin levels are potential candidates for EONS biomarkers.KEYWORDS: EONS, NLR, presepsin, procalcitonin

Consistently low levels of histidine-rich glycoprotein as a new prognostic biomarker for sepsis: A multicenter prospective observational study.

Few sepsis biomarkers accurately predict severity and mortality. Previously, we had reported that first-day histidine-rich glycoprotein (HRG) levels were significantly lower in patients with sepsis and were associated with mortality. Since the time trends of HRG are unknown, this study focused on the time course of HRG in patients with sepsis and evaluated the differences between survivors and non-survivors. A multicenter prospective observational study was conducted involving 200 patients with sepsis in 16 Japanese hospitals. Blood samples were collected on days 1, 3, 5, and 7, and 28-day mortality was used for survival analysis. Plasma HRG levels were determined using a modified quantitative sandwich enzyme-linked immunosorbent assay. First-day HRG levels in non-survivors were significantly lower than those in survivors (mean, 15.7 [95% confidence interval (CI), 13.4-18.1] vs 20.7 [19.5-21.9] μg/mL; P = 0.006). Although there was no time × survivors/non-survivors interaction in the time courses of HRG (P = 0.34), the main effect of generalized linear mixed models was significant (P < 0.001). In a univariate Cox proportional hazards model with each variable as a time-dependent covariate, higher HRG levels were significantly associated with a lower risk of mortality (hazard ratio, 0.85 [95% CI, 0.78-0.92]; P < 0.001). Furthermore, presepsin levels (P = 0.02) and Sequential Organ Function Assessment scores (P < 0.001) were significantly associated with mortality. Harrell's C-index values for the 28-day mortality effect of HRG, presepsin, procalcitonin, and C-reactive protein were 0.72, 0.70, 0.63, and 0.59, respectively. HRG levels in non-survivors were consistently lower than those in survivors during the first seven days of sepsis. Repeatedly measured HRG levels were significantly associated with mortality. Furthermore, the predictive power of HRG for mortality may be superior to that of other singular biomarkers, including presepsin, procalcitonin, and C-reactive protein.

Клінічні особливості перебігу неонатального сепсису з урахуванням запальної відповіді організму

The study of the clinical features of the course of neonatal sepsis depending on the level of C-reactive protein and presepsin in the dynamics makes it possible to distinguish a cohort of children with a «severe» course of sepsis, who require complex monitoring of life-supporting functions. Purpose - to study the clinical features of the course of neonatal sepsis and to distinguish the signs of «severe» sepsis for the purpose of an individualized approach to the choice of treatment tactics. Materials and methods. 56 medical records of newborns with neonatal sepsis were analyzed. Depending on the level of the inflammatory response, two observation groups were formed. The clinical Group I included 25 patients with neonatal sepsis with a level of C-reactive protein (CRP) &lt;20 mg/l (boys - 52.0%, city residents - 80.0%). The Group II was formed by 31 newborns with sepsis, in whom the content of CRP in the blood was &gt;20 mg/l (boys - 62.8% (p&gt;0,05), city residents - 57.1% (p&gt;0,05)). The content of presepsin in the blood serum of newborns of both comparison groups exceeded 300 pg/ml. According to the main clinical characteristics, these groups were comparable. According to the time of manifestation of clinical signs of sepsis, the distribution by groups was gomogenous. Results. A comprehensive clinical examination of newborns with neonatal sepsis on the 1st and the 3rd day of treatment gave reason to believe that signs of organ dysfunction are not associated with the severity of acute-phase indicators of the immunological response. However, on the 7th day of treatment, in patients with higher indicators of the inflammatory response, the preservation of signs of organ dysfunction, namely certain neurological, respiratory, hemodynamic disorders, changes in nutritional status, were noted. Conclusions. A comprehensive clinical examination of newborns with neonatal sepsis in the dynamics revealed that the preservation of more pronounced signs of organ dysfunction is inherent in patients with higher inflammatory response rates on the 7th day of inpatient treatment. Based on the obtained data, it is shown that the cohort of children with neonatal sepsis was heterogeneous with certain characteristic features depending on immunological reactivity. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the parents was obtained for the research. No conflict of interests was declared by the authors.

Presepsin as a promising biomarker for early detection of post-operative infection in children.

Post-operative systemic inflammation response syndrome (SIRS) is an event that results from surgical trauma, white blood cells contact activation, and intra-surgical bacterial translocation, which is difficult to distinguish from sepsis. Presepsin is a novel biomarker that is increased since the early stages of bacterial infection and can be used to confirm the diagnosis of post-operative infectious complications. This study aimed to investigate the diagnostic performance of presepsin for post-operative infectious complications compared to other well-known biomarkers. This cross-sectional study included 100 post-operative patients admitted to Cipto Mangunkusumo National Hospital and Bunda Hospital in Jakarta, Indonesia. The objective was to identify the optimal cutoff and trend of plasma presepsin concentration on the first and third day after surgery and to compare them with other biomarkers. Plasma presepsin level was higher in the infection group compared to the non-infection group (median 806.5 pg/ml vs. 717 pg/ml and 980 pg/ml vs. 516 pg/ml on the first and third day, respectively). Presepsin levels tended to increase on the third post-operative day (median + 252 pg/ml) in children with infection. The opposite trend was observed in the non-infection group from the first to the third day (median -222.5 pg/ml). Presepsin delta, a three-day difference between the first and third post-operative day, had the best diagnostic performance compared to other biomarkers (Area Under the Curve 0.825). The optimal cutoff for presepsin delta to diagnose post-operative infection was +90.5 pg/ml. Serial assessments of presepsin levels on the first and third days post-surgery and their trends are helpful diagnostic markers for clinicians to detect post-operative infectious complications in children.

Oxidative and Inflammatory Parameters in Children and Adolescents With ADHD

Objective: This study aims that oxidative stress and inflammation status in children and adolescents with attention deficit hyperactivity disorder (ADHD) compared to their healthy peers. Method: Thirty ADHD and healthy controls were included in this study. ADHD diagnosis according to the DSM-V and Conners’ teacher and parent rating scale by a structured psychiatric interview. Total oxidant status (TOS), total antioxidant status (TAS), and total and native thiol levels were determined using photometric methods. Presepsin, Interleukin (IL) 1-ß, IL-6, and Tumor Necrosis Factor-alpha (TNF-α) levels were measured with commercial ELISA kits. Results: We showed that TOS and oxidative stress index were significantly higher in the ADHD group, and TAS was lower than in the control group (p<.001). Similarly, IL1-ß, IL-6, and TNF-α levels were statistically higher in the ADHD group. Backward LR regression analysis reveals that TOS and IL-6 predicted ADHD. Conclusion: TOS and IL-6 levels may play a role in the pathogenesis of ADHD.

Standardized Criterion of Presepsin Reference Interval for Accurate and Early Diagnosis of Sepsis

Background: Presepsin is a soluble analog of CD14, recently validated as a new biomarker for sepsis. Different cut-off levels of Presepsin for the diagnosis of sepsis have been proposed however, the optimum threshold for early clinical discrimination of sepsis from non-infectious conditions remains unknown. Objective: This work was undertaken to define the reference interval of Presepsin for Sepsis according to the CLSI C28-A3c approved guideline. Methods: Reference individuals (N=72) receiving in-patient care at ICU for sepsis and complications were selected for the study. Presepsin concentrations were measured by enzyme-linked immunosorbent assay. Reference limits were calculated using the non-parametric robust method. Results: Overall, the reference range for Presepsin in sepsis patients was 24.2 -872.2 pg/mL (90% confidence interval). Peak values for males were relatively higher than for females and the presepsin concentrations were influenced by age. Conclusion: Proposed reference interval could assist in accurate and early diagnosis of sepsis which would eventually improve the outcome in patients of all age groups.

Increased level of presepsin in patients with acutely decompensated cirrhosis predicts development of acute-on-chronic liver failure

Increased level of presepsin in patients with acutely decompensated cirrhosis predicts development of acute-on-chronic liver failure

The evaluation of presepsin level and bacterial infection in neutropenic patients

Aim: Neutropenia is a life-threatening condition that is seen as a complication of chemotherapy, especially in cancer patients, if the patient is infected. Early treatment of the infection has aimportant effect on mortality. Our aim in this study is to investigate the usability of presepsin in terms of diagnosis of bacterial infection in patients who are neutropenic after chemotherapy. Methods: In this study, presepsin, erythrocyte sedimentation rate (ESR), CRP (C-reactive protein), and procalcitonin were measured in 25 neutropenic patients, and a comparison was made between those who were culture positive and negative, those who had a fever and those who did not. In addition, presepsin and CRP values were compared with the control group of 22 people. Results: Presepsin, CRP, ESR and procalcitonin were significantly higher in those who did not reproduce in each culture (p&lt;0.001, p=0.003, p=0.026, p&lt;0.01, respectively) compared to those who did not have a fever (p&lt;0.001, p&lt;0.001, p &lt; 0.001, p=0.019, respectively). Conclusion: Presepsin has the potential to be used in the early evaluation of bacterial infection in neutropenic patients. However, more work should be done on this issue.

Usefulness of phase angle on bioelectrical impedance analysis as a surveillance tool for postoperative infection in critically ill patients.

Bioelectrical impedance analysis (BIA) has advantages of obtaining results quickly, safely, reproducibly, and non-invasively. Phase angle (PhA) is one of the parameter of BIA, its values represent the permeability or integrity of cell membrane. With the exception of C-reactive protein (CRP), few studies have estimated an association between PhA and these conventional biomarkers. Herein, we aimed to investigate the association between the PhA value and the conventional inflammatory markers in postoperative patients in intensive care unit (ICU). Also, the correlation between the change in PhA and the occurrence of infectious complication were determined. From July 2020 to February 2022, retrospective observation study conducted in 221 patients who admitted to ICU after abdominal surgery. BIA measurements and blood sampling were routinely performed the next morning. The relationship between PhA and the inflammatory markers were assessed after adjusting for age and body mass index. Univariate and multivariate logistic regression analysis was performed to examine the predisposing factors for postoperative infections. Among 221 patients admitted to ICU after abdominal surgery, infectious complications occurred in 62 cases. CRP, procalcitonin, or presepsin levels were negatively correlated with PhA in both gender. (-0.295, -0.198 or -0.212 of partial correlation coefficients, respectively in males, and 0.313, -0.245 or -0.36 of partial correlation coefficients, respectively in females) But, white blood cell did not show significant association with PhA in both genders. For males, increased level of CRP on postoperative day 1 (POD1) was revealed as the significant predicting factor for postoperative infectious complication [odds ratio (OR): 1.184, 95% confidence interval (CI): 1.090-1.285, p < 0.001]. For females, increased Acute Physiology and Chronic Health Evaluation II score at admission (OR: 1.457, 95% CI: 1.068-1.987, p = 0.018), increased level of presepsin on (OR: 1.003, 95% CI: 1.001-1.006, p = 0.016) and decreased value of PhA on POD1 (OR: 0.980, 95% CI: 0.967-0.993, p = 0.003) were revealed as the significant predicting factors. Phase angle obtained through BIA can be used as a predictor of infection as it shows a significant association with inflammatory markers. Phase angle measurements through BIA could improve patient prognosis after abdominal surgery through the careful observation of infections and early, appropriate treatment.