ORIGINAL ARTICLE   

Minerva Anestesiologica 2020 November;86(11):1170-9

DOI: 10.23736/S0375-9393.20.13661-7

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Validity of presepsin for the diagnosis and prognosis of sepsis in elderly patients admitted to the Intensive Care Unit

Shuang WANG ^{1, 2, 3}, Wen-Qing RUAN ³, Zhuang YU ³, Xiang ZHAO ³, Zhi-Xia CHEN ^{1, 3} ✉, Quan LI ^{1, 3}

¹ Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China; ² Department of Anesthesiology, Xuzhou Central Hospital of Jiangsu Province, Xuzhou, China; ³ Department of Anesthesiology, East Hospital, Tongji University School of Medicine, Shanghai, China

BACKGROUND: Preliminary reports suggested that presepsin was a powerful biomarker for sepsis in a general population. However, presepsin levels change with age. This study aimed to investigate the diagnostic and prognostic value of presepsin among elderly patients with sepsis in the intensive care unit (ICU).
METHODS: A total of 142 elderly patients were enrolled and assorted into three groups: non-infection, infection, and sepsis. Blood samples were collected on days 1, 3 and 7 during the first week of ICU stay for presepsin measurement. Diagnostic and prognostic utilities were tested by receiver operating characteristic, cutoff levels, Kaplan Meier survival curves and hazard ratios.
RESULTS: The presepsin level on days 1 and 3 were significantly higher in sepsis compared with infection (P<0.01) and non-infection (P<0.01). The diagnostic area under the curve (AUC) of presepsin was comparable to that of procalcitonin (P>0.05) and higher than that of C-reactive protein or interleukin 6 (P<0.05) on days 1 and 3. In AUC and Kaplan-Meier survival curves, presepsin on day 3 showed a significant prognostic value for 30-day mortality but was not superior to other biomarkers.
CONCLUSIONS: The presepsin level was significantly higher in elderly patients with sepsis compared with the non-infection and infection groups. Presepsin has a reliable early diagnostic ability for sepsis comparable to that of PCT. However, it cannot be defined as a perfect biomarker for prognosis of 30-day mortality in elderly patients. An overall and continual assessment of all the clinical indexes for sepsis during the course of the disease is necessary.

KEY WORDS: Aged; Intensive Care Unit; Human presepsin protein; Sepsis