Performance of presepsin and procalcitonin predicting culture-proven bacterial infection and 28-day mortality: A cross sectional study

Abstract

Presepsin is a highly specific biomarker for diagnosing bacterial infections, but its clinical usefulness is not well validated. A retrospective cross-sectional study was conducted. Among the patients suspected bacterial infection or fulfilled the criteria of systemic inflammatory response syndrome (SIRS) and patients who underwent blood culture, presepsin, procalcitonin (PCT), and C-reactive protein (CRP) at the same time were included. Receiver operating characteristic (ROC) curve analysis and logistic regression were used to compare performance of three biomarkers. A total of 757 patients were enrolled, including 256 patients (33.8%) with culture-proven bacterial infection and 109 patients (14.4%) with bacteremia. The 28-day mortality rate was 8.6%. ROC curve analysis revealed that the area under the curve (AUC) of PCT was higher than that of presepsin for both culture-proven bacterial infection (0.665 and 0.596, respectively; p = 0.003) and bacteremia (0.791 and 0.685; p < 0.001). In contrast, AUC of PCT for 28-day mortality was slower than presepsin (0.593 and 0.720; p = 0.002). In multivariable logistic regression analysis, PCT showed the highest ORs for culture-proven bacterial infection (OR 2.23, 95% CI 1.55–3.19; p < 0.001) and for bacteremia (OR 5.18, 95% CI 3.13–8.56; p < 0.001), while presepsin showed the highest OR for 28-day mortality (OR 3.31, 95% CI 1.67–6.54; p < 0.001). CRP did not show better performance than PCT or presepsin in any of the analyses. PCT showed the best performance predicting culture-proven bacterial infection and bacteremia, while presepsin would rather be useful as a prognostic marker.

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

“…Presepsin, the soluble fraction of cluster of differentiation 14 (CD14), is a sepsis biomarker that is released into circulation when monocytes are activated after binding with lipopolysaccharides (LPS) and LPS-binding proteins ( 29 , 30 ). Recently, Park et al ( 31 ) reported that presepsin showed a higher AUC than PCT (0.720 and 0.593; p = 0.002) for the prediction of 28-day mortality in 757 patients with bacterial infection, whereas the AUC of presepsin for detecting culture-proven bacteremia was lower than that of PCT (0.685 and 0.791; p < 0.001). As NE-SFL/NE-WY showed a higher AUC than presepsin, we consider presepsin to predict mortality rather than the presence of bacteremia in sepsis patients.…”