Diagnostic and prognostic value of presepsin vs. established biomarkers in critically ill patients with sepsis or systemic inflammatory response syndrome.

Background: Inflammatory biomarkers may aid to distinguish between systemic inflammatory response syndrome (SIRS) vs. sepsis. We tested the hypotheses that (1) presepsin, a novel biomarker, can distinguish between SIRS and sepsis, and (2) higher presepsin levels will be associated with increased severity of illness and (3) with 28-day mortality, outperforming traditional biomarkers. Methods: Procalcitonin (PCT), C-reactive protein (CRP), presepsin, and lactate were analyzed in 60 consecutive patients (sepsis and SIRS, n = 30 per group) on day 1 (D1) to D3 (onset sepsis, or after cardiac surgery). The systemic organ failure assessment (SOFA) score was determined daily. Results: There was no difference in mortality in sepsis vs. SIRS (12/30 vs. 8/30). Patients with sepsis had higher SOFA score vs. patients with SIRS (11 +/- 4 vs. 8 +/- 5; p = 0.023), higher presepsin (AUC = 0.674; p < 0.021), PCT (AUC = 0.791; p < 0.001), CRP (AUC = 0.903; p < 0.0001), but not lactate (AUC = 0.506; p = 0.941). Unlike other biomarkers, presepsin did not correlate with SOFA on D1. All biomarkers were associated with mortality on D1: presepsin (AUC = 0.734; p = 0.0006; best cutoff = 1843 pg/mL), PCT (AUC = 0.844; p < 0.0001), CRP (AUC = 0.701; p = 0.0048), and lactate (AUC = 0.778; p < 0.0001). Multiple regression analyses showed independent associations of CRP with diagnosis of sepsis, and CRP and lactate with mortality. Increased neutrophils (p = 0.002) and decreased lymphocytes (p = 0.007) and monocytes (p = 0.046) were also associated with mortality. Conclusions: Presepsin did not outperform traditional sepsis biomarkers in diagnosing sepsis from SIRS and in prognostication of mortality in critically ill patients. Presepsin may have a limited adjunct value for both diagnosis and an early risk stratification, performing independently of clinical illness severity.