The Role of Presepsin in Diagnosing Infections in Patients with Liver Cirrhosis and Overt Hepatic Encephalopathy

Abstract

Infections and sepsis represent severe liver cirrhosis (LC) complications and the precipitating factors of hepatic encephalopathy (HE). The early diagnosis and treatment of infections in patients with LC and HE can significantly increase their survival. Presepsin is a serum biomarker evaluated for the early diagnosis of infections and sepsis in the general and cirrhotic populations. This study aimed to evaluate the role of presepsin in the early diagnosis of infections in patients with LC and HE. This prospective observational study included all consecutive cirrhotic patients admitted to our tertiary university center with overt HE. The patients were follow-up until discharge. In this study, we included 365 patients with a median age of 59 years, of whom 61.9% were male. Infections were diagnosed in 134 patients (36.7%). The presepsin level was higher in patients with infections than those without infections (3167 vs. 500, p < 0.001). The ROC analysis results demonstrated that the best cut-off value for presepsin in infections detection was 980 pg/mL with a sensitivity of 80.17%, specificity of 82.5% (AUROC 0.869, CI 95%: 0.819–0.909, p < 0.001, Youden index J of 0.622), a positive predictive value of 40.63%, and a negative predictive value of 96.53%. In conclusion, in patients with LC and overt HE, presepsin levels >980 pg/mL could enhance the suspicion of bacterial infections. Presepsin may be an adequate non-invasive tool for the early diagnosis of infections in patients with LC and overt HE.

Gut Microbiota and Biomarkers of Endothelial Dysfunction in Cirrhosis

“…In total, 47 patients and 27 healthy individuals were assessed (Figure 1). Patients and controls did not differ in age (49 [44][45][46][47][48][49][50][51][52][53][54][55][56] vs. 48 [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] years; p = 0.372) or sex distribution (male/female: 18/29 vs. 10/17; p = 0.558). The characteristics of patients with cirrhosis are presented in Supplementary Table S1.…”

“…The treatment of phagocytes with LPS did not lead to the formation of presepsin, in contrast to treatment with live or dead bacterial cells. This protein is considered to be a diagnostic biomarker for sepsis [34][35][36][37][38]. Therefore, presepsin can be considered as a universal biomarker for the cellular bacterial translocation of both Gram-positive and Gram-negative bacteria, while LPS is a biomarker for both the cellular translocation of whole living or dead Gram-negative bacterial cells and the molecular translocation of single LPS molecules or LPS molecules in fragments of dead Gram-negative bacteria.…”

The value of presepsin and procalcitonin as prognostic factors for mortality in patients with alcoholic liver cirrhosis and acute on chronic liver failure

“…Presepsin, a protein derived from the co-receptor for bacterial ligands CD14, serves as an effective biomarker of innate immune activation and is useful for early infection diagnosis in cirrhotic patients [ 35 , 36 ]. In a previous study, we demonstrated that presepsin levels ≥2300 pg/mL were associated with infections in ACLF patients [ 12 ]. Furthermore, we found a direct correlation between presepsin levels, disease severity assessed by MELD score, and Child-Pugh class.…”

“…Infections in ACLF significantly contribute to higher mortality rates and pose a considerable challenge in the management of this complex condition [ 10 - 12 ]. Patients with ACLF are particularly susceptible to infections due to immune dysregulation, impaired liver function, and systemic complications [ 10 ].…”

“…Patients with ACLF are particularly susceptible to infections due to immune dysregulation, impaired liver function, and systemic complications [ 10 ]. Infection-related complications can further compromise the already altered liver function in ACLF patients, leading to multi-organ dysfunction, sepsis, and increased mortality risk [ 11 , 12 ]. Sepsis is a life-threatening condition caused by an extreme response to infection, leading to tissue damage, organ failure, and potentially death [ 13 ].…”