Presepsin for the Detection of Late-Onset Sepsis in Preterm Newborns

Abstract

BACKGROUND: Late-onset sepsis (LOS) is among the leading causes of morbidity and mortality in preterm newborns, and currently available diagnostic tools are inadequate. The objective of this study was to evaluate the accuracy of presepsin (P-SEP) as novel biomarker of bacterial infection for the diagnosis of LOS in preterm newborns. METHODS:We prospectively studied newborns #32 weeks' gestational age with LOS (n = 19) and noninfected controls (n = 21) at 4 to 60 days' postnatal age. At enrollment, and 1, 3, and 5 days later, we ascertained the C-reactive protein, procalcitonin, and P-SEP in the LOS group, whereas P-SEP alone was ascertained in the control group.RESULTS: P-SEP at enrollment was higher in the LOS than the control group (median 1295 vs 562 ng/L, P = .00001) and remained higher throughout the study period. In the LOS group, P-SEP had a borderline reduction at day 1 versus values at enrollment (median 1011 vs 1295 ng/L, P = .05), whereas C-reactive protein and procalcitonin at day 1 did not differ from baseline values. The receiver operating characteristic curve of P-SEP at enrollment shows an area under the curve of 0.972. The best calculated cutoff value was 885 ng/L, with 94% sensitivity and 100% specificity. Negative likelihood ratio was 0.05, and positive likelihood ratio was infinity. CONCLUSIONS:We demonstrated for the first time in a cohort of preterm newborns that P-SEP is an accurate biomarker for the diagnosis of possible LOS and may also provide useful information for monitoring the response to therapeutic interventions. WHAT'S KNOWN ON THIS SUBJECT:Early diagnosis of LOS in preterm infants may be challenging because of the questionable accuracy of blood culture and the common markers of infections, such as C-reactive protein and procalcitonin. WHAT THIS STUDY ADDS:Our study demonstrated for the first time that P-SEP is an accurate biomarker for the diagnosis of LOS in preterm infants and might contribute to the monitoring of infant response to therapeutic interventions.

Presepsin as an Early Reliable Diagnostic and Prognostic Marker of Neonatal Sepsis.

“…These results agree with Poggi C et al [5] who found that CRP utility is questionable because its peak values are reached only after a 2-to 3-day delay after the infective stimulus, and its value can increase after non-infective inflammatory events.…”

“…These results were close to Poggi C et al [5] results who found that The area under the ROC curve for Presepsin was 0.972 (95% confidence interval [CI] 0.92-1.00) and that presepsin achieved the best accuracy for prediction of probable sepsis at the cutoff of 885 ng/L with 94% sensitivity (95% CI 74-100) and 100% specificity (95% CI 84-100). The positive and negative predictive values were 100% (95% CI, 83-100) and 95% (95% CI, 80-100).…”

“…Presepsin has recently been described as a reliable diagnostic and prognostic marker of sepsis. [5] The aim of this study is to compare presepsin level in neonatal sepsis with CRP level which is the most frequently used marker for neonatal sepsis in Egypt and with CBC results to evaluate presepsin as a potential early diagnostic and a reliable prognostic marker for neonatal sepsis.…”

The role of CRP, PCT, IL-6 and presepsin in early diagnosis of bacterial infectious complications in paediatric haemato-oncological patients

“…We determined low cut off levels and weak specificity and PPV in contrast to good sensitivity and high NPV. There are only few existing paediatric studies focused on analysis of presepsin's diagnostic usefulness, mainly in newborns [18,21]. Papers considered febrile episodes in childhood oncology patients reported also inconclusive results [17,20].…”

Presepsin (sCD14-ST) as a biomarker of sepsis in clinical practice and in emergency department: a mini review

“…Accordingly, another study suggested presepsin as an accurate biomarker for the diagnosis of possible LOS. In this study, authors also stated that it might provide useful information for monitoring response to therapeutic interventions [20]. Mussap et al [21] investigated presepsin levels of neonates with severe disease, and they could not determine any correlation between gestational age and presepsin levels.…”