Diagnostic and prognostic role of presepsin in patients with cirrhosis and bacterial infection

Ferrarese, Alberto; Frigo, Anna Chiara; Mion, Monica; Plebani, Mario; Russo, Francesco Paolo; Germani, Giacomo; Gambato, Martina; Cillo, U.; Cattelan, Annamaria; Burra, Patrizia; Senzolo, Marco

doi:10.1515/cclm-2020-1212

Cited by 17 publications

(27 citation statements)

References 37 publications

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“…In both cases, PSP had significant cutoff values at T0 and T1, as well as a high PSP level of more than 1000 pg/mL for ICU mortality. Previous studies hypothesized that PSP can be used not only to predict the potential occurrence of sepsis but also mortality [ 1 , 34 , 35 , 36 , 37 ]. Similarly, our study results demonstrated that PSP may play a pivotal role in predicting ICU and in-hospital mortality, as well as the onset of sepsis during early postoperative phase, even in patients with mild AKI.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Postoperative Sepsis Based on Changes in Presepsin Levels of Critically Ill Patients with Acute Kidney Injury after Abdominal Surgery

Kim

2021

Diagnostics

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Presepsin (PSP) is a viable biomarker for the detection of bacterial infection, but it lacks accuracy when acute kidney injury (AKI) develops. Herein, we evaluated the diagnostic and prognostic value of PSP in predicting postoperative sepsis after abdominal surgery respective to the degree of AKI. A total of 311 patients who underwent abdominal surgery and were admitted to a surgical intensive care unit were enrolled and classified into non-AKI, mild-AKI (stage 1, stage 2 and stage 3 without renal replacement therapy (RRT)) and severe-AKI (stage 3 with RRT) group, according to the Kidney Disease Improving Global Outcomes criteria. In each group, PSP and other biomarkers were statistically analyzed between non-sepsis and postoperative sepsis at the admission (T0), 24 h (T1), 48 h (T2) and 72 h (T3) after surgery. In non-AKI and mild-AKI group, PSP levels were significantly higher in postoperative sepsis than non-sepsis group, whereas no difference was detected in the severe-AKI group. Cutoff values of PSP in the mild-AKI group for the prediction of postoperative sepsis were 544 pg/mL (AUC: 0.757, p < 0.001) at T0 and 458.5 pg/mL (AUC: 0.743, p < 0.001) at T1, significantly higher than in non-AKI group. In multivariate analysis, predictors of postoperative sepsis in the mild-AKI group were PSP at T2 (odds ratio (OR): 1.002, p = 0.044) and PSP at T3 (OR: 1.001, p = 0.049). PSP can be useful for predicting newly developed sepsis in patients with transient AKI after abdominal surgery with modified cutoff values.

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Section: Discussionmentioning

confidence: 99%

Prediction of Postoperative Sepsis Based on Changes in Presepsin Levels of Critically Ill Patients with Acute Kidney Injury after Abdominal Surgery

Kim

2021

Diagnostics

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“…Presepsin level in the liver may have been elevated without infection due to inflammation and fibrosis from underlying diseases [ 35 , 36 ]. Furthermore, presepsin level tends to increase with cirrhosis progression and renal dysfunction, even without infections [ 17 , 18 , 37 ]. Therefore, the reason for the increased level may be cirrhosis progression, hepatorenal syndrome, or potential inflammation.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with procalcitonin and CRP, presepsin is a superior diagnostic biomarker in terms of accuracy and detects infections in the earlier phase [ 12 , 13 , 15 , 16 ]. In patients with liver cirrhosis, presepsin level tends to increase with cirrhosis progression even without infection and is associated with survival rate [ 17 ]. Thus, the usefulness of presepsin for diagnosing infection in patients with liver cirrhosis who require LT is controversial [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…In patients with liver cirrhosis, presepsin level tends to increase with cirrhosis progression even without infection and is associated with survival rate [ 17 ]. Thus, the usefulness of presepsin for diagnosing infection in patients with liver cirrhosis who require LT is controversial [ 17 , 18 ]. Similarly, in patients with end-stage kidney disease, although presepsin level increases even without infection with disease progression, it decreases to normal levels after kidney transplantation [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Utility of Presepsin in Infections After Liver Transplantation: A Preliminary Study

et al. 2021

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Background Infectious complications after solid organ transplantation can be fatal, and early diagnosis and intervention are important. To the best of our knowledge, no study has examined the diagnostic utility of presepsin, a known accurate biomarker, for infectious complications after liver transplantation. This study aimed to evaluate the utility of presepsin for detecting infection and perioperative kinetics of presepsin after liver transplantation. Material/Methods This single-institutional prospective, observational study included 13 patients who underwent living-donor or deceased-donor liver transplantation. Perioperative serum presepsin level was measured 6 times within a week to evaluate its association with infectious complications and compare it with procalcitonin and C-reactive protein levels and leukocyte count. Postoperatively, patients were followed up for 15 days for infectious complications. Results Five of the 13 patients developed infectious complications after liver transplantation. The median time for infection diagnosis was 9 postoperative days (25 th –75 th percentile, 7–10). Presepsin levels on 5 and 7 postoperative days were significantly higher in patients with infection than in those without ( P =0.019 and P =0.011, respectively). In receiver operating characteristic analysis, area under the curve values of presepsin on 5 and 7 postoperative days (0.881 and 0.905, respectively) were higher than those of other biomarkers. The optimal cut-off value of presepsin was 1361 pg/mL on postoperative day 5 and 1375 pg/mL on postoperative day 7. Conclusions Although this study included a small number of patients, presepsin levels on postoperative days 5 and 7 may be useful indicators for infectious complications after liver transplantation.

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“…Different biological markers were tested over time to diagnose infections and/or sepsis in patients with LC [ 7 , 8 , 9 , 10 , 11 ]. C-reactive protein (CRP), procalcitonin (PCT), and presepsin are practical to be used in daily clinical practice and were evaluated in patients with different stages of LC as the markers of infections or sepsis [ 10 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

The Role of Presepsin in Diagnosing Infections in Patients with Liver Cirrhosis and Overt Hepatic Encephalopathy

et al. 2022

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Infections and sepsis represent severe liver cirrhosis (LC) complications and the precipitating factors of hepatic encephalopathy (HE). The early diagnosis and treatment of infections in patients with LC and HE can significantly increase their survival. Presepsin is a serum biomarker evaluated for the early diagnosis of infections and sepsis in the general and cirrhotic populations. This study aimed to evaluate the role of presepsin in the early diagnosis of infections in patients with LC and HE. This prospective observational study included all consecutive cirrhotic patients admitted to our tertiary university center with overt HE. The patients were follow-up until discharge. In this study, we included 365 patients with a median age of 59 years, of whom 61.9% were male. Infections were diagnosed in 134 patients (36.7%). The presepsin level was higher in patients with infections than those without infections (3167 vs. 500, p < 0.001). The ROC analysis results demonstrated that the best cut-off value for presepsin in infections detection was 980 pg/mL with a sensitivity of 80.17%, specificity of 82.5% (AUROC 0.869, CI 95%: 0.819–0.909, p < 0.001, Youden index J of 0.622), a positive predictive value of 40.63%, and a negative predictive value of 96.53%. In conclusion, in patients with LC and overt HE, presepsin levels >980 pg/mL could enhance the suspicion of bacterial infections. Presepsin may be an adequate non-invasive tool for the early diagnosis of infections in patients with LC and overt HE.

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Diagnostic and prognostic role of presepsin in patients with cirrhosis and bacterial infection

Cited by 17 publications

References 37 publications

Prediction of Postoperative Sepsis Based on Changes in Presepsin Levels of Critically Ill Patients with Acute Kidney Injury after Abdominal Surgery

Prediction of Postoperative Sepsis Based on Changes in Presepsin Levels of Critically Ill Patients with Acute Kidney Injury after Abdominal Surgery

Diagnostic Utility of Presepsin in Infections After Liver Transplantation: A Preliminary Study

The Role of Presepsin in Diagnosing Infections in Patients with Liver Cirrhosis and Overt Hepatic Encephalopathy

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