Presepsin as Early Marker of Sepsis in Emergency Department: A Narrative Review

Abstract

The diagnosis and treatment of sepsis have always been a challenge for the physician, especially in critical care setting such as emergency department (ED), and currently sepsis remains one of the major causes of mortality. Although the traditional definition of sepsis based on systemic inflammatory response syndrome (SIRS) criteria changed in 2016, replaced by the new criteria of SEPSIS-3 based on organ failure evaluation, early identification and consequent early appropriated therapy remain the primary goal of sepsis treatment. Unfortunately, currently there is a lack of a foolproof system for making early sepsis diagnosis because conventional diagnostic tools like cultures take a long time and are often burdened with false negatives, while molecular techniques require specific equipment and have high costs. In this context, biomarkers, such as C-Reactive Protein (CRP) and Procalcitonin (PCT), are very useful tools to distinguish between normal and pathological conditions, graduate the disease severity, guide treatment, monitor therapeutic responses and predict prognosis. Among the new emerging biomarkers of sepsis, Presepsin (P-SEP) appears to be the most promising. Several studies have shown that P-SEP plasma levels increase during bacterial sepsis and decline in response to appropriate therapy, with sensitivity and specificity values comparable to those of PCT. In neonatal sepsis, P-SEP compared to PCT has been shown to be more effective in diagnosing and guiding therapy. Since in sepsis the P-SEP plasma levels increase before those of PCT and since the current methods available allow measurement of P-SEP plasma levels within 17 min, P-SEP appears a sepsis biomarker particularly suited to the emergency department and critical care.

Presepsin Predicts Severity and Secondary Bacterial Infection in COVID-19 by Bioinformatics Analysis

“…PCT is often elevated due to the secondary response of cytokines, resulting in an unsatisfactory early diagnosis of sepsis [ 21 ]. In addition, according to currently available methods, presepsin levels can be detected within 17 minutes, which is significantly shorter than the detection time of PCT [ 14 ]. But even so, most studies do not recommend the use of presepsin as a single biomarker for sepsis diagnosis, but in combination with other sepsis markers and traditional diagnostic tools such as bacterial culture [ 22 ].…”

“…The most important feature of presepsin is that it increases significantly in the early stage of sepsis. Compared with other biomarkers such as PCT, the plasma presepsin concentration increases earlier, which can significantly distinguish sepsis from nonsepsis [ 14 ]. In addition, this early timing feature also endows presepsin the superior diagnostic ability, which can be used for early diagnosis of postoperative sepsis [ 25 ].…”

“…Presepsin plays a role in recognizing different ligands of Gram-positive and Gram-negative bacteria and stimulating inflammatory responses [ 13 ]. Presepsin may be an effective and reliable biomarker for the identification of systemic inflammatory response syndrome caused by bacterial infection, especially Gram-negative bacteria [ 14 ]. However, the role of presepsin in COVID-19 has not been fully illuminated yet.…”

The Interplay between Host Defense, Infection, and Clinical Status in Septic Patients: A Narrative Review

“…In the immune response to sepsis, the serum levels of PSEP do increase before the ones for procalcitonin or IL-6, so it has been proposed as a potential biomarker of infection and systemic inflammation, with proposed cut-off levels for sepsis of 400–600 pg/mL. Used alone, as well as in conjunction with other established biomarkers, PSEP has been shown to provide useful insight to distinguish between normal and pathological conditions, graduate the disease severity, guide treatment, monitor therapeutic responses, and predict prognosis [ 123 , 124 , 125 ].…”

Sepsis: New Challenges and Future Perspectives for an Evolving Disease—Precision Medicine Is the Way!

“…The possible application of new diagnostic markers was evaluated by Piccioni et al who reviewed the current literature on the use of presepsin and proadrenomedullin in the setting of ED [16,17]. Presepsin is a fragment of the soluble form of CD14 (sCD14), after being cleaved by plasma cathepsin D; it contributes to the activation of the innate immune response.…”