Presepsin: A potential biomarker of PJI? A comparative analysis with known and new infection biomarkers

Abstract

There is still no "gold standard" for the diagnosis and prognosis of post-operative periprosthetic joint infection (PJI). Among serum biomarkers, an emerging molecule is presepsin, the soluble fraction of CD14, recently described in other settings as a powerful diagnostic tool to detect sepsis at different degrees of severity. The aim of this study was to investigate the diagnostic and prognostic value of presepsin in PJI. A total of 30 patients with PJI and 30 patients without PJI were enrolled. Presepsin, C-reactive protein (CRP), serum interleukin (IL)-6, triggering receptor expressed on myeloid cells 1 (TREM-1), CCL2, matrix metalloproteinase 9 (MMP-9), CD163, osteopontin (OPN), and toll-like receptor 2 (TLR2) were measured at different times after surgery. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were analyzed for each biomarker. Presepsin showed greater diagnostic value than CRP and IL-6; CD163, TREM-1, and MMP-9 had very low diagnostic potential. Presepsin, OPN, CCL2, suPAR, and TLR2 all decreased significantly with increasing time of recovery after surgery in PJI patients. Presepsin can be considered a useful tool for the diagnosis and clinical monitoring of PJI and can be backed by a panel of new inflammatory markers involved in monocyte-/macrophage-mediated inflammatory responses, such as OPN, CCL2, TLR2, and suPAR.

Improved diagnosis of chronic hip and knee prosthetic joint infection using combined serum and synovial IL-6 tests

“…Many novel serum and synovial biomarkers, such as CD14, TREM-1, and TLR2, have shown potential in the diagnosis of PJI. 8 However, marker detection techniques are not readily available in many hospitals, and conflicts exist between different studies, making the test results difficult to interpret. It is interesting to note these cytokines are upstream of the inflammatory pathway, and will eventually trigger the expression of the cytokine interleukin-6 (IL-6) under septic conditions.…”

Alpha-defensins determination in different types of synovial fluid and parallel collected serum samples by ELISA

“…They concluded that presepsin has the potential to be a new biomarker of septic arthritis. At the same time, Marazzi et al 29 examined this marker in patients with PJI and demonstrated its higher diagnostic value compared with CRP and IL-6. However, in our study, when comparing presepsin with HNP1-3, no statistically significant correlation was demonstrated in either serum or synovial fluid.…”

The prognostic value of Presepsin for postoperative complications following pancreatic resection: A prospective study

“…This data is in contrast to prior published data of several different surgical disciplines: Marazzi et al assessed Presepsin as a potential biomarker for periprostetic joint infection in a cohort of 30 patients with periprostetic joint infection compared to 30 without. In their series, Presepsin showed greater diagnostic value as assessed by ROC-AUC than established markers for postoperative infections such as CRP or IL-6, namely AUC 0.926 compared to AUC 0.750 and AUC 0.821 [ 27 ]. Also in cardiac surgery patients, Presepsin has shown a comparable predictive value for major adverse events as procalcitonin and even a better predictive value for in-hospital and 6-months mortality [ 28 ].…”