Presepsin as a novel diagnostic and prognostic sepsis biomarker

Abstract

Despite their undoubted helpfulness in diagnosing sepsis, increased blood C-reactive protein (CRP) and procalcitonin (PCT) levels have been described in many noninfectious conditions. Furthermore, CRP and PCT have a limited value for risk stratification and outcome prediction. Presepsin is a soluble fragment of the cluster of differentiation 14 (CD14) involved in pathogen recognition by innate immunity. We aimed to investigate the diagnostic and prognostic performance of presepsin in comparison to PCT and CRP in patients presenting with systemic inflammatory response syndrome (SIRS) and suspected sepsis. Seventy-six subjects were enrolled in this study, including 51 patients with SIRS as well as 25 healthy subjects. Plasma presepsin, PCT and CRP levels were serially measured at 5 time points (on admission and at days 1, 3, 7 and 15). Presepsin and PCT yielded similar diagnostic accuracy with area under the receiver operating characteristic (ROC) curves (AUCs) of 0.805 and 0.780, respectively, (P=0.755), whereas presepsin performed significantly better than CRP for diagnosing sepsis (AUC, 0.805 vs. 0.613; P=0.029). PCT showed a trend towards a better diagnostic performance than CRP (AUC, 0.780 vs. 0.613; P=0.062). PCT and presepsin showed comparable performance for predicting 28-day mortality with AUCs of 0.932 and 0.891, respectively, (P =0.465), whereas PCT and presepsin performed significantly better than CRP (AUC=0.445; P<0.001) in predicting 28-day mortality. In septic patients, presepsin showed the highest concentration on day 3 and tended to decrease on day 7, whereas PCT and CRP showed the highest concentration on day 7 and tended to decrease on day 15, suggesting that presepsin revealed earlier concentration changes over time when compared to PCT and CRP. Presepsin and PCT could differentiate between septic and non-septic patients with comparable accuracy and both biomarkers showed similar performance for predicting 28-day mortality. Early changes in presepsin concentrations might reflect the appropriateness of the therapeutic modality and could be useful for making effective treatment decisions.