Presepsin as a predictor of critical colonization in CLI hemodialysis patients

Abstract

Infection during critical limb ischemia (CLI) is a challenging issue. Plasma presepsin is a novel biomarker for infection, which is related to bacterial phagocytosis by macrophages. The purpose of this study was to investigate the validity of presepsin as an indicator and predictor for early detection of infectious CLI. A retrospective observational study was conducted among 20 CLI patients (Rutherford 5 and 6) on hemodialysis (HD). Twenty CLI patients on HD (mean age 70.7 6 5.6 years, male 85%) and 15 healthy patients on HD without CLI and infection (control group) were analyzed. All CLI patients received appropriate revascularization and plastic surgical treatment. CLI patients were classified into two groups: the healing group with complete epithelialization without discharge and the nonhealing group with infection signs. Plasma presepsin was measured and compared among the two groups and the control group using an automated immunoanalyzer, PATHFAST, based on a noncompetitive chemiluminescent enzyme immunoassay. The median plasma presepsin and its interquartile range were 1,320 (1,055-1,465) pg/mL in the control group, 1,320 (1,050-1,613) pg/mL in the healing group and 3,193 (2,519-3,832) pg/mL in the nonhealing group. The plasma presepsin concentrations were significantly higher in the nonhealing group compared with the control group (p < 0.001) and the healing group (p < 0.01). A receiver operating characteristic curve analysis revealed that presepsin had highest accuracy (0.979) among various inflammatory markers, including C-reactive protein and the white blood cell count. The diagnostic cutoff value of 2,083 pg/mL was able to distinguish the nonhealing group and healing group with a sensitivity of 100% and a specificity of 88.9%. Our results suggest that plasma presepsin may be useful for predicting "critical colonization" and "infection" in nonhealing CLI in HD patients, therefore, the definitive cutoff value may be used for determinating the indication for reintervention and/or major limb amputation. Foot gangrene due to critical limb ischemia (CLI) is a life-threatening complication in hemodialysis (HD) patients. The serum C-reactive protein (CRP) level and presence of gangrene are reported to be independent predictors for the failure of the endovascular treatment (EVT) in HD patients with CLI. 1-3 The risk factors of CLI include heart failure, infection, HD, and malnutrition. In the management of CLI, both revascularization and wound treatment are important. Despite successful revascularization with EVT and/or bypass surgery, poor infection control during wound treatment could result in major limb amputation or death. The survival rates with major limb amputation are quite poor: 51.9% at 1 year and 14.4% at 5 years. 4 Thus, infection control is a challenging issue in wound treatment. At present, predictors of the prognosis include the white blood cell (WBC) count and CRP level, and clinical observation and an assessment of the wound. Because the WBC count and CRP level could increase as a reflection ...

Targeted metagenomic assessment reflects critical colonization in battlefield injuries

“…These outcomes were determined by clinicians at the time of sampling and two primary wound metrics were examined; overall wound closure outcome (successful delayed wound closure or failed healing, defined by requiring additional surgical debridement intervention after delayed wound closure was attempted) and critical colonization (bacterial load of >10 5 per g of tissue/µL fluid). The definition of critical colonization used here does not imply deleterious signs of infection or host response, but only total microbial quantification exceeding a defined quantity of microorganisms measured per unit of specimen investigated ( 22 , 23 ). Final timepoint samples were used based on sample availability, according to the patient standard of care treatment, representing local wound microenvironments proximal to the time of delayed closure.…”

Presepsin is a potent biomarker for diagnosing skin wound infection in hemodialysis patients compared to white blood cell count, high-sensitivity C-reactive protein, procalcitonin, and soluble CD14

“…The cut-off value (2080 pg/mL) for diagnosing skin wound infection was close to that (2083 pg/mL) for predicting the prognosis of foot gangrene [8].…”

“…In contrast to conventional infection biomarkers which are induced by endotoxins or cytokines, the novel production mechanism of presepsin has been reported to be closely related to phagocytosis by monocytes [6,7]. We previously reported the usefulness of presepsin for predicting the prognosis of foot gangrene in HD patients (cut-off plasma value 2083 pg/mL) [8]. In the present study, we hypothesized that presepsin might be useful for diagnosing localized infection, and we compared the diagnosing ability of presepsin for skin wound infection in HD patients with that of conventional infection biomarkers: white blood cell count (WBC) and levels of high-sensitivity C-reactive protein (hsCRP), soluble CD14 (sCD14), and procalcitonin (PCT).…”

Letters: Response to ‘Food for thought: innovation and debate’ Journal of Wound Care July 2017; 26: 7.

“…11 Presepsin was recently identified as a predictor of critical colonisation in haemodialysis patients with critical limb ischaemia. 12 Until a consensus can be reached on a definition for critical colonisation, or an unequivocal biomarker found, debate about the nature of critical colonisation is likely to continue. It was therefore our consensus through a Modified Delphi process and a review of the literature from 2008 to 2015 that the term was deleted.…”