Presepsin teardown - pitfalls of biomarkers in the diagnosis and prognosis of bacterial infection in cirrhosis

doi:10.3748/wjg.v22.i41.9172

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Retrospective Study

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

Peter Antal-Szalmas, Andrea Sumegi, Tamas Dinya, David Tornai, Istvan Tornai, Zsuzsanna Vitalis, Tamas Tornai, Maria Papp

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.

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
Processing time: 130 Days and 21.2 Hours

Core Tip

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.