Diagnostic and Prognostic Values of Presepsin in Patients with Sepsis

Abstract Introduction Sepsis is a life-threatening medical emergency and adult sepsis survivors experienced significant, long-term morbidity. Despite the great improvement in the detection of this medical condition, septic patients are a heterogeneous group and their condition has been very difficult to be recognized especially in the early stages. Early sepsis is easily misdiagnosed as systemic inflammatory response (SIRS), leading to delayed treatment. If sepsis is not treated quickly, it can cause organ failure, septic shock or even death. Therefore, more specific markers are required for the diagnosis of sepsis Aim of the Work This study evaluated the diagnostic value of presepsin level as a sepsis biomarker compared to other sepsis biomarkers’ levels (CRP/Procalcitonin/ LDH/ lactate) in patients with sepsis and compared between the predictive value of sepsis biomarkers (CRP/procalcitonin /LDH/lactate/ presepsin) and mortality scores (SOFA/qSOFA/ APACHEII). Patients and Methods This study was held on seventy-six hospitalized ward and ICU patients in Ain Shams University hospital with suspected or confirmed infection who met two or more Systemic Inflammatory Response Syndrome (SIRS) criteria and thirty healthy controls during 18 months (from January 2022 to June 2023). The patients were classified according to positivity of culture results into (sepsis group) (fifty-one patients) and (SIRS group) (twenty-five patients). A consecutive sampling method was fulfilled according to inclusion and exclusion criteria. Results The median presepsin level in the patients was 500ng/L versus 65 ng/L in the controls with (P 0.0001). There was no significant different between the sepsis group and the SIRS group regarding sepsis biomarkers’ levels (CRP/procalcitonin/LDH/lactate/presepsin) with P value (0.144), (0.116), (0.711), (0.425) and (0.484) respectively. But there was a significant decrease in day 3 follow up sepsis biomarkers (CRP/procalcitonin/ LDH/ lactate/presepsin) with P value (0.003, 0.008, 0.001, 0.002 & 0.001 respectively). The follow up 28 days mortality rate was (25%). There was a significant high baseline SOFA score and qSOFA score with 28 days mortality (P 0.025 & 0.036 respectively). There was a significant correlation between presepsin and qSOFA score (P 0.016). However, there was no significant correlation between presepsin level and both SOFA score and APACHEII score. There was a significant direct proportion between baseline serum level of lactate and 28 days mortality rate (P value 0.032). Baseline presepsin level for predicting 28 days mortality wasn’t significant (P 0.391). However, persistently high day 3 presepsin level for predicting 28 days mortality was significant (p value 0.027). Conclusion Presesin and other biomarkers were important for sepsis screening but not specific for diagnosis. Baseline presepsin level cannot differentiate between (sepsis group) & (SIRS group). The base line presepsin level wasn’t significant only in predicting 28 days mortality follow up but the baseline lactate was significant. However, day 3 presepsin level was significant in predicting 28 days mortality follow up.