Presepsin usefulness in intensive care unit

INTRODUCTION. The first cause of mortality in critically ill patients is sepsis. Various sepsis biomarkers have been studied in the past years and commonly used ones include C-Reactive Protein (CRP) and Pro- calcitonin (PCT). A new biomarker is sCD-14-st, known as Presepsin (P-SEP), derived from mCD14, co-receptor of the Toll-like Receptor 4 for LPS. Its utility in critical ill patients has yet to be defined. OBJECTIVES. To prospectively assess the potential role of presepsin in the diagnosis of sepsis and its prognostic value in a critical care setting. METHODS. All adult patients admitted to one of the ICUs of the University Hospital Integrated Trust of Verona were prospectively screened from June 2016 to January 2017. Patients < 18 yrs, those admitted for < 48-hr observation, and those who refused to participate were excluded. Sepsis and septic shock were defined daily (patient-day) according to new standard criteria1. We recorded demographic characteristics, daily clinical and laboratory data, procalcitonin (PCT) and presepsin (P-SEP) plasmatic levels. Serum P-SEP levels were measured on ICU admission and then daily until ICU discharge using luminescent monoclonal antibodies (“pathfast method”). At the fifth day we used SOFA score variation (delta-SOFA score) to divide patients in favourable (delta-SOFA < 2) and unfavourable (delta-SOFA > 2) clinical course. RESULTS. 97 patients (57 men) were included. Median age was 73 (62–80) yrs, APACHE II and SOFA score at admission were 14 (10–21) and 7 (5–10), respectively. Admissions were due to medical conditions (n = 66), elective surgery (n = 24) and emergency surgery (n = 7). Sepsis was diagnosed at admission in 69 patients (71.1%), whose 29 had septic shock (29.8%). Overall ICU mortality was 17.5%. P-SEP levels in septic shock patients were significantly higher than in those classified as septic and non-septic (1966 (909–4845) vs 1226 (730–2223) vs 504 (373–856) pg/ml, respectively. PCT showed the same trend and thus similar accuracy, as showed by ROC AUC of 0.82 for both biomarkers (P-SEP best cut-off = 1036 pg/ml). No correlation was found between P-SEP and the APACHE II score (r = 0,29). However, differently from PCT, P-SEP trend was signifi- cantly different between survivors/non-survivors and, during the first five days, between favourable/unfavourable course (p < 0.001, two way ANOVA. CONCLUSIONS. In ICU patients P-SEP concentrations are increased in septic patients and show similar prognostic power than PCT. P-SEP trends may represent a promising early prognostic marker of both recovery and mortality.