Perinatal asphyxia partly affects presepsin urine levels in non-infected term infants

Abstract

Objectives Standard of care sepsis biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT) can be affected by several perinatal factors, among which perinatal asphyxia (PA) has a significant role. In this light, new early sepsis biomarkers such as presepsin (P-SEP) are needed to enact therapeutic strategies at a stage when clinical and laboratory patterns are still silent or unavailable. We aimed at investigating the potential effects of PA on longitudinal P-SEP urine levels. Methods We conducted an observational case-control study in 76 term infants, 38 with PA and 38 controls. Standard clinical, laboratory, radiological monitoring procedures and P-SEP urine measurement were performed at four time-points (first void, 24, 48, 96 h) after birth. Results Higher (p<0.05) CRP and PCT blood levels at T1–T3 were observed in PA than control infants whilst no differences (p>0.05, for all) at T0 were observed between groups. P-SEP urine levels were higher (p<0.05) in PA at first void and at 24 h while no differences (p>0.05) at 48 and 96 h were observed. No significant correlations were found (p>0.05) between P-SEP and urea (R=0.11) and creatinine (R=0.02) blood levels, respectively. Conclusions The present results, showed that PA effects on P-SEP were limited up to the first 24 h following birth in absence of any kidney function bias. Data open the way to further investigations aimed at validating P-SEP assessment in non-invasive biological fluids as a reliable tool for early EOS and LOS detection in high-risk infants.

Perinatal asphyxia does not influence presepsin levels in neonates: A prospective study

“…The difference in presepsin concentration in the urine of our asphyxiated patients appeared to be slightly significant only in the first hours of life. Furthermore, in the present study, we found no correlations between plasma presepsin and parameters of renal function during all the observed periods, in contrast to what is described in adult literature 12,16 …”

“…Previous studies have reported a higher level of blood presepsin in adult patients receiving haemodialysis as well as in uninfected adult patients with severe acute kidney failure. 12,16 However, urinary presepsin levels were never measured in this category of patients.…”

“…These findings are consistent with previous studies. 3,12,21 Recently, Okumuş et al demonstrated that also therapeutic hypothermia is associated with an increase in CRP levels: in patients who underwent therapeutic hypothermia, CRP levels gradually increased during the course of the treatment, peaked on day 4 and then gradually declined while CRP levels in the control group did not change statistically within the same time period (the first 72 h) (p = 0.065). 21 However, it is not still clear whether it is the hypoxic state or the effect of hypothermia that influences plasma CPR levels, and further studies about new biomarkers are warranted.…”

“…Moreover, the authors confirmed that CRP and procalcitonin blood levels in hypoxic babies were elevated in the absence of any sign of infection. 12 In this study, we compared presepsin levels in the blood and urine of uninfected neonates with perinatal asphyxia undergoing therapeutic hypothermia and in a group of uninfected and un-asphyxiated neonates as controls. Then, we explored whether blood presepsin, CRP and procalcitonin levels were influenced by therapeutic hypothermia.…”

“…[9][10][11] Moreover, the accuracy of presepsin measured in biological fluids other than blood has yet to be completely confirmed. 12 Several authors have documented that the blood presepsin levels in adults seem to increase with renal impairment. 13 Botondi et al investigated presepsin levels in urine samples of neonates with perinatal asphyxia.…”