Presepsin Research Articles

Changes of Early Sepsis Biomarker Presepsin Level during Hemodialysis: Influence of β2-Microglobulin Clearance of Dialysis Membrane: A Preliminary Study

Background: Although presepsin (P-SEP) is an early sepsis biomarker, sepsis is often suspected after starting hemodialysis (HD). To enhance the utility of P-SEP, we investigated whether pre-HD P-SEP levels could be predicted using the P-SEP levels from blood samples collected after starting HD. Methods: We observed P-SEP level changes due to HD and dialyzer passage in HD patients using a dialysis membrane with a β₂-microglobulin (β₂-MG) clearance of either ≥50 mL/min (high-flux) or < 30 mL/min (intermediate-flux). We calculated the removal ratios for the elimination of P-SEP or the predicted pre-HD P-SEP levels based on the correction of hemoconcentration. Results: The P-SEP levels significantly decreased at 4 h after starting HD (n = 8) using membranes with a β₂-MG clearance ≥50 mL/min; the removal ratios at 2 and 4 h were 42.8 ± 7.9% and 58.8 ± 18.4%, respectively. In contrast, the P-SEP levels did not decrease during the passage of dialyzer in 2 patients with a β₂-MG clearance < 30 mL/min, and the P-SEP levels increased during HD in all patients (n = 10, including the abovementioned 2 patients) with a β₂-MG clearance < 30 mL/min. The predicted pre-HD P-SEP levels (y) were strongly correlated with the actually measured pre-HD P-SEP levels (x) (R² = 0.9562) using the regression equation: y = 1.0987x. Conclusion: The levels of P-SEP with a molecular weight near that of β₂-MG decreased similarly to those of β₂-MG during HD using membranes with a β₂-MG clearance ≥50 mL/min. On the contrary, the levels of P-SEP rather increased during HD with a β₂-MG clearance < 30 mL/min, suggesting that P-SEP appeared not to be eliminated. Furthermore, the pre-HD P-SEP levels might be predictable by the correction of hemoconcentration using even blood samples collected after starting HD with a β₂-MG clearance < 30 mL/min.

Efficacy of presepsin, procalcitonin, Il-6 and C-reactive protein for diagnosis of system and local infection in patients with acute necrotizing pancreatitis

Introduction: Sepsis and organ failure are results of progress of infected acute necrotizing pancreatitis (ANP) and their development significantly worsens its prognosis. Early diagnosis of infection can improve results of their management. Aim of study was to establish the efficacy of presepsin (PSP), procalcitonin (PCT), Il-6 and C-reactive protein (CRP) for diagnosis of local and system infection during ANP. Method: In 70 patients with ANP levels of PSP, PCT, Il-6 and CRP at admission and during treatment were determined and compared with bacteriological assays, complications and mortality rates. Results: The positive results of bacteriological examination were obtained in 43 cases. In patients with ANP and system inflammatory response syndrome without infection the concentration of the PSP increased to 332±38 pg/ml (healthy control - 184±16 pg/ml, p< 0.05). There was direct dependence of PSP concentration from severity of infection: at local infection its level reached 677±30 pg/ml, sepsis - 988±47 pg/ml and severe sepsis - 2668±102 pg/ml. PCT concentgration over 2.5 ng/ml differentiated septic cases but changes in patients with local infection were insignificant (p˃0.05). High rates of Il-6 and CRP were common in patients with system inflammatory response syndrome of both infectious and noninfectious origin. ROC AUC value of PSP for all types of infection complications reached 0.956±0.007 (p<0.001) and was significantly higher (p˂0.05) than ROC AUC of PCT, Il-6 and CRP. Conclusion: PSP concentration is early highly sensitive and specific marker for all kind of infection complications during ANP and exceeds diagnostic utility of PCT, Il-6 and CRP.

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.

Postoperative Changes in Presepsin Level and Values Predictive of Surgical Site Infection After Spinal Surgery: A Single-Center, Prospective Observational Study.

Single-institutional, prospective observational study. To elucidate the perioperative kinetics of presepsin (PSEP) in patients undergoing spinal surgery, and to evaluate the possibility of PSEP in the early diagnosis of surgical site infection (SSI). Early diagnosis of SSI after spinal surgery is important. Although several biomarkers have been used as early indicators of SSI, the specificity of these markers in SSI diagnosis was not high. PSEP was found as a novel diagnostic marker for bacterial sepsis in 2004. However, its kinetics after spinal surgery and its usefulness in early diagnosis of SSI have never been evaluated. A total of 118 patients who underwent elective spinal surgery were enrolled. PSEP was measured before, immediately after, 1 day after, and 1 week after surgery. In patients without postoperative infection, perioperative kinetics of PSEP were analyzed. PSEP levels in patients with postoperative infection were also recorded separately, and their utility in SSI diagnosis was evaluated. In the 115 patients without postoperative infection, the median PSEP value was 126, 171, 194, and 147 pg/mL before, immediately after, 1 day after, and 1 week after surgery, respectively. Compared with the preoperative value, PSEP was significantly higher immediately after surgery and the next day, and return to the preoperative level 1 week after surgery. The estimated reference value for 95 percentile in patients without postoperative infection was 297 pg/mL 1 week after surgery. In three patients with postoperative infection, higher levels (>300 pg/mL) were observed 1 week after surgery. In patients after spinal surgery without infectious complications, blood levels of PSEP may immediately increase and return to preoperative levels 1 week after surgery. The PSEP value of 300 pg/mL 1 week after surgery might be used as a novel indicator for suspected SSI. 4.

Diagnóstico y pronóstico de sepsis con presepsina en el Departamento de Urgencias

IntroductionSoluble presepsin (PSEP) a subtype of CD14 or sCD14-ST is a complex product of CD14 cleavage that is released into the general circulation and can now be quantified by a rapid automated method. The circulating levels of PSEP can be perceived as a control of activated monocytes-macrophages in response to pathogens. Thus, PSEP represents a biomarker of the initial phase of the systemic infection. The objective of the study is to evaluate the diagnostic and prognostic value of PSEP in subjects with sepsis and septic shock in an emergency department. Materials and methodsPilot, observational, prospective study was conducted on 50 subjects who fulfilled the selection criteria, and admitted to the Emergency Department during the period July 2016 to January 2017. The demographic variables, diagnosis of sepsis or septic shock, and mortality were collected. Biomarker analyses were performed, and compared for the early diagnosis of infection, such as: presepsin (PSEP), procalcitonin, C-reactive protein, on admission, at 48hours, and on the seventh day. NT-proBNP was performed at hour 0. ResultsThe mean age of the subjects in the study was 69.8 years (SD ± 15,6), and 46% of the participants were men. The subjects were stratified into 3groups: chronic kidney disease (CKD) with sepsis/shock (n = 14), sepsis (n = 21), and septic shock (n = 15). When comparing the means of the quantitative variables, and depending on which of the 3observation groups they belonged, it was found that the PSEP value at zero hour was significantly different (P<.05), being notable in the participants with kidney disease, and in those with septic shock. Similarly, it was found that the value of NT-proBNP at hour 0, and the Sepsis-related organ failure assessment (SOFA) score at zero hour, and at 48hours had significant differences (P<.05). Statistical analysisThe analysis of the information was performed using measurement of central tendency and dispersion. The cut-off points established for sepsis, septic shock, and patients with CKD were applied to the sample in the contingency table to evaluate the diagnostic test, its sensitivity, specificity, PPV and NPV, and ROC curve. CommentPSEP demonstrated its diagnostic and prognostic value in sepsis in this pilot study. A national Multicentre study will be used to validate the test in Colombia and demonstrate its diagnostic efficacy.

Cerebrospinal Fluid Presepsin As a Marker of Nosocomial Infections of the Central Nervous System: A Prospective Observational Study.

Nosocomial CNS infection (NI-CNS) is a common and serious complication in neurocritical care patients. Timely, accurate diagnosis of NI-CNS is crucial, yet current infection markers lack specificity and/or sensitivity. Presepsin (PSP) is a novel biomarker of macrophage activation. Its utility in NI-CNS has not been explored. We first determined the normal range of cerebrospinal fluid (CSF) PSP in a control group without brain injury before collecting data on CSF PSP levels in neurocritical care patients. Samples were analyzed in four groups defined by systemic and neurological infection status. CSF PSP levels in 15 control patients without neurological injury were 50-100 pg/ml. Ninety-seven CSF samples were collected from 21 neurocritical care patients. In patients without NI-CNS or systemic infection, CSF PSP was 340.4 ± 201.1 pg/ml. Isolated NI-CNS was associated with CSF PSP levels of 640.8 ± 235.5 pg/ml, while levels in systemic infection without NI-CNS were 580.1 ± 329.7 pg/ml. Patients with both NI-CNS and systemic infection had CSF PSP levels of 1,047.7 ± 166.2 pg/ml. In neurocritical care patients without systemic infection, a cut-off value of 321 pg/ml gives sensitivity and specificity for NI-CNS of 100 and 58.3%, respectively. CSF PSP may prove useful in diagnosing NI-CNS, but its current utility is as an additional marker only.

Presepsin as a predictor of positive blood culture in suspected neonatal sepsis.

Although the incidence of neonatal sepsis is decreasing, neonatal sepsis remains a severe life-threatening disease. No current biochemical marker can provide perfect diagnostic accuracy for neonatal sepsis. The aim of this study was therefore to evaluate the accuracy of presepsin (P-SEP) as a novel biomarker of bacterial infection for neonatal sepsis diagnosis. We prospectively studied newborns with sepsis (sepsis group; n = 13) during the first 30days after birth and compared them with control preterm newborns (control group; n = 18). In addition, we evaluated term newborns with some clinical signs of early onset sepsis (non-sepsis term group; n = 35). P-SEP in the sepsis group was significantly higher than in the control group (P < 0.001) The area under the curve for P-SEP was 0.868 (95%CI: 0.71-1.00). A P-SEP cut-off of 795pg/mL was established, with 85% sensitivity and 89% specificity. The positive and negative predictive values were 85% and 89%, respectively. In the non-sepsis term group, P-SEP had better stability than white blood cells and C-reactive protein for 3days after birth. P-SEP can better discriminate between infections and non-infectious inflammatory conditions than the currently used biomarkers.

Serum Presepsin Levels Are Not Elevated in Patients with Controlled Hypertension

Introduction Hypertension (HT) is a common serious condition associated with cardiovascular morbidity and mortality. The pathogenesis of HT is multifactorial and has been widely investigated. Besides the vascular, hormonal, and neurological factors, inflammation plays a crucial role in HT. Many inflammatory markers such as C-reactive protein, cytokines, and adhesion molecules have been studied in HT, which supported the role of inflammation in the pathogenesis of HT. Presepsin (PSP) is a novel biomarker of inflammation. Therefore, the potential relationship between PSP and HT was investigated in this study. Methods Forty-eight patients with controlled HT and 48 controls without HT were included in our study. Besides routine clinical and laboratory data, PSP levels were measured in peripheral venous blood samples from all the participants. Results PSP levels were significantly lower in patients with HT than in controls (144.98 ± 75.98 versus 176.67 ± 48.12 pg/mL, p = 0.011). PSP levels were positively correlated with hsCRP among both the patient and the control groups (p = 0.015 and p = 0.009, resp.). However, PSP levels were not correlated with WBC among both groups (p = 0.09 and p = 0.67, resp.). Conclusions PSP levels are not elevated in patients with well-controlled HT compared to controls. This result may be associated with anti-inflammatory effects of antihypertensive medicines.

Incidence of elevated procalcitonin and presepsin levels after severe trauma: a pilot cohort study.

Procalcitonin (PCT) and presepsin (PSEP) are useful biomarkers for diagnosing sepsis; however, elevated PCT and PSEP levels may be observed in conditions other than sepsis. We hypothesised that PCT and PSEP levels could increase after severe traumatic injuries. Trauma patients with an Injury Severity Score of ≥16 from October 2013 to September 2015 were enrolled in our study. We examined PCT and PSEP levels and their positive rates on days 0 and 1. PCT and PSEP levels on days 0 and 1 were compared. Risk factors for increasing sepsis biomarker levels were identified by multivariate logistic regression analyses. In this study, 75 patients were included. PCT levels on days 0 and 1 were 0.1±0.4 and 1.8±6.3 ng/ml, respectively (P=0.02). PSEP levels on days 0 and 1 were 221±261 and 222±207 pg/ml, respectively (P=0.98). As per multivariate logistic regression analyses, packed red blood cell (PRBC) transfusion was the only independent risk factor for higher PCT levels on day 1 (P=0.04). Using PCT to diagnose sepsis in trauma patients on day 1 requires caution. PRBC transfusion was found to be a risk factor for increasing PCT levels. On the other hand, PSEP levels were not affected by trauma during the early phases.

Presepsin (sCD14-ST): could it be a novel marker for the diagnosis of ST elevation myocardial infarction?

IntroductionAcute myocardial infarction (AMI) could be considered to be a state of inflammation. Many inflammatory markers have been evaluated in the AMI setting so far. Presepsin (PSP) is a novel biomarker for diagnosis and prognosis of systemic inflammation that has not been studied in the AMI setting to date. In this study, we aimed to examine serum PSP levels in patients with acute ST elevation myocardial infarction (STEMI).Material and methodsForty-eight patients with STEMI and fifty healthy controls without coronary artery disease, verified by coronary angiography, were included in the study. Together with routine laboratory tests needed for STEMI, plasma concentrations of PSP were measured in peripheral venous blood samples of the participants.ResultsPlasma PSP and troponin levels were significantly higher in patients with STEMI than controls (1988.89 ±3101.55 vs. 914.22 ±911.35 pg/ml, p = 0.001 and 3.46 ±3.39 vs. 0.08 ±0.43 ng/ml, p = 0.001, respectively). The cut-off value for PSP of 447 pg/ml was found to detect STEMI with 87.5% sensitivity, 44% specificity, 60% positive predictive value and 78.5% negative predictive value.ConclusionsIn this study, PSP levels were found to be significantly elevated in patients with STEMI together with high-sensitivity troponins. The PSP may be a new marker for AMI detection. Large scale studies are needed to reveal the importance of PSP in the diagnosis and prognosis of AMI.

Diagnostic and Prognostic Value of Biochemical Markers of Infectious Complications of High-Dose Therapy with Autologous Hematopoietic Stem Cell Transplantation in Malignant Lymphoproliferative Diseases

Aim. To evaluate diagnostic and prognostic value of C-reactive protein (CRP), procalcitonin (PCT) and presepsin (PSP) in patients with malignant lymphoproliferative disorders after a high-dose chemotherapy and auto-HSCT. Methods. 28 patients were included in the study (20 women and 8 men; 12 of them with Hodgkin’s lymphoma, 6 with non-Hodgkin’s lymphomas, and 10 with multiple myeloma). The median age was 40 years (23-66 years). The conditioning regimens were CBV, BEAM or melphalan 200 mg/m&lt;sup&gt;2&lt;/sup&gt;. PSP, PCT and CRP levels were evaluated on the day of admission (DA), D+1, D+3, D+7 and on the day of discharge (DD). Depending on the presence of infectious complications, the patients were divided into 2 groups: group 1 - patients without complications (n = 12), group 2 - patients with complications (n = 16). In group 2 there were 15 patients with febrile neutropenia (FN) and 1 with sepsis. Results. The median (range) of FN development was 5.5 days. Median CRP level on the DA and the DD in group 1 was 2.25 mg/l (0.6-20.4) and 14.85 mg/l (3.7-50), respectively (p = 0.001), while in group 2 it was 3.2 mg/l (0.2-53) and 19.7 mg/l (5.1-152.2), respectively (p = 0.025). However, CRP did not significantly differ between groups 1 and 2 at any point of analysis. The study also demonstrated a significant increase in the PCT levels in both groups after allo-HSCT. Median PCT level on the DA and the DD in group 1 was 0.023 ng/ ml (0.02-0.112) and 0.07 ng/mL (0.02-0.356), respectively (p = 0.04), and in group 2 - 0.039 ng/ml (0.02-0.158) and 0.106 ng/mL (0.045-3.67), respectively (p = 0.001). Comparison of PCT levels on study days demonstrated no significant difference between groups. On the DA the median PSP level in group 1 was 166.5 pg/ml (77.2-476), on the DD it was 199 pg/ml (90-298) (p = 0.78). Median PSP levels in group 2 on the DA (129 pg/ml, range 84.2-501) and also on the DD (288.5 pg/ml, range 83.4-1345) were significantly different (p = 0.03). In the comparative analysis of PSP in groups 1 and 2, there were no significant differences on the DA and on the D+1. Significant difference in PSP levels between the analyzed groups was on the D+3, D+7 and on the DA. Conclusion. The preliminary data showed that PSP is the most sensitive marker of infectious complications in patients with lymphoproliferative diseases after auto-HSCT.

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

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

Diagnostic accuracy of procalcitonin and presepsin for infectious disease in patients with acute kidney injury

Procalcitonin (PCT) and presepsin (PSEP) are sepsis markers, but their diagnostic accuracy may be compromised in acute kidney injury (AKI). We evaluated their diagnostic accuracy in patients with/without AKI. This retrospective study comprised 91 patients with at least one criterion of systematic inflammatory response syndrome. AKI markers plasma neutrophil gelatinase-associated lipocalin (NGAL), plasma cystatin C (CysC), and estimated glomerular filtration rate (eGFR) were measured upon hospital admission and on days 1, 3, 5, and 7. Patients were divided into non-AKI and AKI groups. APACHE II severity scores were determined. PCT and PSEP levels were increased significantly in non-AKI and AKI patients with infection. NGAL, CysC, and eGFR in patients with infection were associated with PCT, PSEP, and APACHE II score, and levels of PCT and PSEP were correlated significantly with disease severity. PCT and PSEP are useful markers of bacterial infections in AKI but different thresholds should be applied.

Presepsin for the detection of late-onset sepsis in preterm newborns.

Late-onset sepsis (LOS) is among the leading causes of morbidity and mortality in preterm newborns, and currently available diagnostic tools are inadequate. The objective of this study was to evaluate the accuracy of presepsin (P-SEP) as novel biomarker of bacterial infection for the diagnosis of LOS in preterm newborns. We prospectively studied newborns ≤32 weeks' gestational age with LOS (n = 19) and noninfected controls (n = 21) at 4 to 60 days' postnatal age. At enrollment, and 1, 3, and 5 days later, we ascertained the C-reactive protein, procalcitonin, and P-SEP in the LOS group, whereas P-SEP alone was ascertained in the control group. P-SEP at enrollment was higher in the LOS than the control group (median 1295 vs 562 ng/L, P = .00001) and remained higher throughout the study period. In the LOS group, P-SEP had a borderline reduction at day 1 versus values at enrollment (median 1011 vs 1295 ng/L, P = .05), whereas C-reactive protein and procalcitonin at day 1 did not differ from baseline values. The receiver operating characteristic curve of P-SEP at enrollment shows an area under the curve of 0.972. The best calculated cutoff value was 885 ng/L, with 94% sensitivity and 100% specificity. Negative likelihood ratio was 0.05, and positive likelihood ratio was infinity. We demonstrated for the first time in a cohort of preterm newborns that P-SEP is an accurate biomarker for the diagnosis of possible LOS and may also provide useful information for monitoring the response to therapeutic interventions.

Prognostic value of sCD14-ST (presepsin) in cardiac surgery.

IntroductionPrediction of complications and mortality after cardiac surgery is an important aspect of timely correction of these conditions. One possibility in this case is the use of biomarkers and some prognostic scores.Aim of the studyTo study the prognostic value of presepsin (PSP) as a predictor of postoperative complications development in cardiosurgical patients.Material and methodsPatients operated for acquired heart diseases with cardiopulmonary bypass (CPB) were included in the study (n = 51, age: 58 ± 11 years). Besides routine clinical and laboratory data, PSP and procalcitonin (PCT) levels were monitored perioperatively (before surgery, and on the 1st, 2nd, 3rd and 6th day after surgery).ResultsThere were no clinical signs of infection before surgery in any of the studied patients. We found supranormal PSP levels in 6 patients (11.8%) before operations (543 [519-602] pg/ml, max 1597 pg/ml; normal value: 365 pg/ml). Infectious complications developed in 19 patients (37%). Statistically significant differences in PSP levels, APACHE II (Acute Physiology and Chronic Health Evaluation II) and SOFA (Sequential Organ Failure Assessment) scores in groups of patients with and without infection were documented from the 1st and in PCT from the 2nd day after the operation. The cut-off values were 702 pg/ml, 8.5 points, 7.5 points and 3.3 ng/ml, respectively. Hospital mortality was 13.7% (7 patients); all cases of death were in the group of patients with infectious complications. Statistically significant differences in PCT levels, APACHE II and SOFA scores between the groups with favorable and lethal outcomes were observed from the first postoperative day. The same for PSP levels was documented only on the 3rd postoperative day. The cut-off values were 7.42 ng/ml, 11 points, 8.5 points and 683 pg/ml, respectively.ConclusionThe use of modern biomarkers alongside integral severity-of-disease scores allows prediction of the risk of infectious complications and mortality in cardiosurgical patients.

Examination of the diagnostic accuracy of sepsis using procalcitonin, presepsin and CD64 for patients with or without acute kidney injury

At the moment, we have few reports about the diagnostic accuracy of procalcitonin (PCT), presepsin (P-SEP) and CD64 as a diagnostic marker of sepsis for patients with acute kidney injury (AKI). This study aimed to clarify which is a more useful diagnostic biomarker for sepsis using PCT, P-SEP and CD64 with or without AKI in ICU patients.

Usefulness of presepsin and procalcitonin levels in the diagnosis of sepsis in patients with acute kidney injury

The presepsin (PSEP) and procalcitonin (PCT) levels are useful biomarkers for differentiating between sepsis and non- infectious systemic inflammatory response syndrome (SIRS). The PSEP and PCT levels have been reported to be abnormally high in patients with chronic renal failure. However, there have been no significant investigations regarding the relationships between these biomarkers and the presence of acute kidney injury (AKI) in the diagnosis of sepsis. The purpose of this study was to clarify the diagnostic accuracy of PSEP and PCT levels in patients with AKI.