Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2016; 22(41): 9172-9185
Published online Nov 7, 2016. doi: 10.3748/wjg.v22.i41.9172
Presepsin teardown - pitfalls of biomarkers in the diagnosis and prognosis of bacterial infection in cirrhosis
Maria Papp, Tamas Tornai, Zsuzsanna Vitalis, Istvan Tornai, David Tornai, Tamas Dinya, Andrea Sumegi, Peter Antal-Szalmas
Maria Papp, Tamas Tornai, Zsuzsanna Vitalis, Istvan Tornai, Department of Internal Medicine, Division of Gastroenterology, University of Debrecen, Faculty of Medicine, H-4032 Debrecen, Hungary
David Tornai, Peter Antal-Szalmas, Department of Laboratory Medicine, University of Debrecen, Faculty of Medicine Debrecen, H-4032 Debrecen, Hungary
Tamas Dinya, Institute of Surgery, University of Debrecen, Faculty of Medicine, H-4032 Debrecen, Hungary
Andrea Sumegi, Vascular Biology, Thrombosis and Haemostasis Research Group, Hungarian Academy of Sciences, H-4032 Debrecen, Hungary
Author contributions: Papp M, Tornai I and Antal-Szamas P designed the study; Tornai T, Tornai D, Vitalis Z, Dinya T and Sumegi A performed research; Papp M, Tornai T and Antal-Szalmas P analyzed data; Papp M, Tornai T and Antal-Szalmas P wrote the manuscript; Papp M and Tornai T contributed equally to the work and both should be considered as first authors.
Supported by János Bólyai Research Scholarship of Hungarian Academy of Sciences, No. BO/00426/11; University of Debrecen and Research Grant of National Research, No. RH/885/2013; Development and Innovation Office, No. K115818/2015/1.
Institutional review board statement: The study was reviewed and approved by the Hungarian National Review Board and the Institutional Review Board of the University of Debrecen.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Maria Papp, MD, PhD, Department of Internal Medicine, Division of Gastroenterology, University of Debrecen, Faculty of Medicine, Nagyerdei krt. 98, H-4032 Debrecen, Hungary. papp.maria@med.unideb.hu
Telephone: +36-52-255152 Fax: +36-52-255152
Received: June 28, 2016
Peer-review started: June 29, 2016
First decision: August 8, 2016
Revised: August 26, 2016
Accepted: September 28, 2016
Article in press: September 28, 2016
Published online: November 7, 2016
Abstract
AIM

To evaluate the diagnostic and prognostic value of presepsin in cirrhosis-associated bacterial infections.

METHODS

Two hundred and sixteen patients with cirrhosis were enrolled. At admission, the presence of bacterial infections and level of plasma presepsin, serum C-reactive protein (CRP) and procalcitonin (PCT) were evaluated. Patients were followed for three months to assess the possible association between presepsin level and short-term mortality.

RESULTS

Present 34.7 of patients had bacterial infection. Presepsin levels were significantly higher in patients with infection than without (median, 1002 pg/mL vs 477 pg/mL, P < 0.001), increasing with the severity of infection [organ failure (OF): Yes vs No, 2358 pg/mL vs 710 pg/mL, P < 0.001]. Diagnostic accuracy of presepsin for severe infections was similar to PCT and superior to CRP (AUC-ROC: 0.85, 0.85 and 0.66, respectively, P = NS for presepsin vs PCT and P < 0.01 for presepsin vs CRP). At the optimal cut-off value of presepsin > 1206 pg/mL sensitivity, specificity, positive predictive values and negative predictive values were as follows: 87.5%, 74.5%, 61.8% and 92.7%. The accuracy of presepsin, however, decreased in advanced stage of the disease or in the presence of renal failure, most probably because of the significantly elevated presepsin levels in non-infected patients. 28-d mortality rate was higher among patients with > 1277 pg/mL compared to those with ≤ 1277 pg/mL (46.9% vs 11.6%, P < 0.001). In a binary logistic regression analysis, however, only PCT (OR = 1.81, 95%CI: 1.09-3.01, P = 0.022) but neither presepsin nor CRP were independent risk factor for 28-d mortality after adjusting with MELD score and leukocyte count.

CONCLUSION

Presepsin is a valuable new biomarker for defining severe infections in cirrhosis, proving same efficacy as PCT. However, it is not a useful marker of short-term mortality.

Keywords: Presepsin, Cirrhosis, Bacterial infection, Organ failure, Mortality

Core tip: C-reactive protein (CRP) and procalcitonin (PCT) are broadly used in clinical practice to aid early diagnosis of bacterial infections, but they have limitations in cirrhosis. Additional biomarkers with enhanced accuracy are highly needed. Presepsin is a novel biomarker of infection and sepsis, but has not been assessed in cirrhosis so far. In the present study we evaluated the diagnostic and prognostic performance of presepsin in cirrhosis-associated infections in comparison with classic acute phase proteins. Presepsin measurement enhanced diagnostic utility of CRP and reflected the severity of infections more accurately, with a similar efficacy as PCT. Advanced disease stage and renal failure limited the diagnostic accuracy. The increase in PCT level but not in presepsin concentration was an independent predictor of short-term mortality during infectious episodes.