Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2021; 9(32): 9857-9868
Published online Nov 16, 2021. doi: 10.12998/wjcc.v9.i32.9857
Presepsin as a biomarker for risk stratification for acute cholangitis in emergency department: A single-center study
Han-Yu Zhang, Zhao-Qing Lu, Guo-Xing Wang, Miao-Rong Xie, Chun-Sheng Li
Han-Yu Zhang, Zhao-Qing Lu, Guo-Xing Wang, Miao-Rong Xie, Chun-Sheng Li, Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Author contributions: Zhang HY, Xie MR, and Li CS designed the study; Zhang HY and Lu ZQ collected the samples and clinical data; Zhang HY measured presepsin, analyzed all the data, and performed the statistical analysis; Wang GX conducted clinical supervision.
Supported by National Natural Science Foundation of China, No. 81773931; and Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support “Yanfan” Project, No. ZYLX201802.
Institutional review board statement: The study was reviewed and approved by the Beijing Friendship Hospital Institutional Review Board (Approval No. 2018-P2-063-01).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Chun-Sheng Li, PhD, Professor, Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-an Road, Xicheng District, Beijing 100050, China. lcscyyy@163.com
Received: June 22, 2021
Peer-review started: June 22, 2021
First decision: July 26, 2021
Revised: July 28, 2021
Accepted: August 27, 2021
Article in press: August 27, 2021
Published online: November 16, 2021
ARTICLE HIGHLIGHTS
Research background

Acute cholangitis is an acute inflammatory reaction caused by bacterial infection in the biliary tract. It progresses rapidly and can develop into sepsis or septic shock. The grade of cholangitis can guide clinical treatment and predict the prognosis of patients. Acute cholangitis is currently graded based on age, temperature, white blood cell (WBC) count, total bilirubin (T-Bil) levels, hypoalbuminemia, and organ/system dysfunction.

Research motivation

Appropriate use of biliary drainage and antibiotics has observably reduced the mortality rate for acute cholangitis. However, the Tokyo Guidelines 2018 (TG18): Diagnostic Criteria and Severity Grading for Acute Cholangitis is a comprehensive criterion and is cumbersome to use in the emergency department.

Research objectives

Presepsin is a promising biomarker for the early diagnosis, severity, and prognosis of acute bacterial infections. To simplify grading, we wanted to evaluate the grading value of presepsin in patients with acute cholangitis.

Research methods

Clinical observational trials were conducted in Beijing Friendship Hospital from 2019 to 2020. Whole blood was collected from patients with acute cholangitis for measuring WBC count, C-reactive protein (CRP), procalcitonin (PCT), presepsin, T-Bil and other clinical biochemical indices. Presepsin levels were measured using the PATHFAST analyzer.

Research results

A total of 336 patients were divided into mild, moderate, and severe groups based on the TG18. The area under the receiver operating characteristic curve (AUC) of presepsin in predicting moderate acute cholangitis was 0.728, prominently higher than that of CRP and PCT. The AUC of presepsin in predicting severe acute cholangitis was 0.715, which was higher than that of WBC count, CRP, PCT, and T-Bil. The WBC count, PCT, and presepsin levels in the positive blood culture group were greater than those in the negative blood culture group, and presepsin had the highest AUC.

Research conclusions

Presepsin can help predict the positive blood culture, and is also superior to WBC count, CRP, PCT, and T-Bil in the risk stratification of acute cholangitis.

Research perspectives

Timely determination of presepsin levels can help clinicians identify the severity of patients with acute cholangitis early. Presepsin may be an ideal biomarker for simplified grading of acute cholangitis.