Presepsin as an Early Diagnostic Biomarker of Sepsis in an Emergency Department

Abstract

Sepsis syndrome is SIRS caused by microbial products, viruses or fungi. Definite and early diagnosis of sepsis is important for avoiding its fatal outcomes and improving the prognosis of patients especially because symptoms and signs are non specific. It can be confused with many conditions that may occur and may be non infectious and has more favorable outcome than sepsis. An accurate inflammatory markers with high diagnostic sensitivity, specificity and NPV for sepsis would be a valuable tool for therapeutic decision-making and avoidance of unnecessary use of antibiotics. Currently used methods in diagnosis have many obstacles ranging from poor sensitivity in case of using blood culture or non specificity in case of depending on CRP. But fortunately presepsin is produced in association with infection and that it is specifically expressed in sepsis. The aim of this study was to study levels of presepsin with sepsis to correlate between their levels and CRP levels in those patients. We also aimed to evaluate the value of these biomarkers in the discrimination between infectious and noninfectious inflammation and to determine which biomarker is better in the early diagnosis of sepsis. The current study included thirty five suspected sepsis patients, in addition to fifteen apparently healthy age and sex matched individuals serving as healthy controls. The study was conducted during the period between December 2015 to Jan 2016. The laboratory work was done in the Clinical Pathology Department, Ain Shams University Hospitals. All subjects under study were subjected to the following laboratory investigations: blood culture, presepsin, CRP, and CBC and results of this study revealed the following: There was a statistically significant increase of presepsin when the comparison was held between: patient group and control group. septic patients and controls, patients with SIRS and controls, septic patients and SIRS patients, sepsis patients and septic shock patients, survived patients and died patients.While median values of presepsin showed no significant increase between: ICU admitted patients and not admitted patients. The best cut off value that could differentiate between survivors and non survivors was 2720 pg/ml. As regards CRP, it was statistically significantly increased when the comparison was held between: patient group and control group, septic patients and controls, The differences between median values of CRP were statistically insignificant between: septic patients and SIRS patients,SIRS patients and controls, sepsis patients and septic shock patients, survived and died patients. Correlation studies revealed that there was no statistically significant correlation between presepsin and other laboratory parameters. The cut off value that gives the best sensitivity and specificity for presepsin was 395 pg/ml. The present study has identified that presepsin can be a very useful new early biomarker for the diagnosis and prognosis of sepsis and discriminating between Sepsis & SIRS.