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Introduction: Presepsin, a subtype of soluble CD14, is an inflammatory marker, which largely reflects monocyte activation and seems to be a precise diagnostic marker of sepsis. However, its clinical significance remains unclear in cardiovascular disease. This prospective study aimed to investigate the prognostic value of plasma presepsin levels, both independently and in combination with B-type natriuretic peptide (BNP), for cardiovascular events in patients with chronic kidney disease (CKD). Methods: We examined 239 outpatients (mean age: 70 years) with non-dialytic CKD (estimated glomerular flirtation rate [eGFR] < 60 mL/min/1.73m2) and measured the baseline plasma presepsin and BNP levels on enrollment. Results: Diabetes was present in 41% of the patients, and prior cardiovascular diseases in 10.0%. Plasma presepsin levels significantly correlated with BNP (r = 0.24; P = 0.0001) and eGFR (r = –0.54; P < 0.0001). During a mean follow-up period of 24.1 months, there were 40 (16.7%) cardiovascular events, including 10 cardiovascular deaths. Patients with a cardiovascular event were older (mean age: 73 vs. 68 years; P = 0.006); had higher levels of presepsin (546 vs. 332 pg/mL; P = 0.0001) and BNP (167 vs. 35 pg/mL; P < 0.0001); and had lower eGFR (15 vs. 24 mL/min/1.73m2; P < 0.0001) than those without a cardiovascular event. In a multivariate Cox regression analysis, both presepsin (P = 0.03) and BNP (P = 0.03) were independent predictors of cardiovascular events. Adding presepsin and BNP levels to a baseline model of established risk factors further enhanced reclassification (P < 0.0001) and discrimination (P < 0.0001) beyond that of the baseline model alone. Presepsin >480 pg/mL (highest tertile value) and/or BNP >80 pg/mL (highest tertile value) were associated with higher cardiovascular mortality and morbidity rates (Table). Conclusions: The combined assessment of presepsin and BNP, which are individually independent predictors of cardiovascular events, could improve the prediction of cardiovascular events in outpatients with non-dialytic CKD. [ABSTRACT FROM AUTHOR]

Background: The early prediction of acute kidney injury (AKI) can facilitate timely intervention and prevent complications. Urinary concentration of liver-type fatty-acid binding protein (L-FABP) reflects tubulointerstitial damage. This prospective study aimed to investigate the predictive value of urinary L-FABP on admission for AKI in patients with worsening heart failure. Methods: We examined 446 patients (mean age: 71 years) hospitalized to coronary care units for worsening heart failure and measured baseline urinary L-FABP levels at admission. AKI was diagnosed and classified according to the KDIGO criteria. Results: NYHA class IV was present in 53% of the patients, diabetes in 39%, and previous history of myocardial infarction in 24%. AKI occurred in 103 (23.1%) patients, including 21 patients with stage 2 or 3 disease. Patients who developed AKI were older (mean age: 73 vs. 70 years, P = 0.04); had a higher prevalence of NYHA class IV (69% vs. 48%; P = 0.0003); had higher levels of N-terminal pro-B-type natriuretic peptide (median: 7399 vs. 3806 pg/mL; P = 0.0003), high-sensitivity C-reactive protein (7.7 vs. 4.1 mg/L; P = 0.004), urinary albumin (234.2 vs. 81.8 mg/gC; P < 0.0001), and urinary L-FABP (53.0 vs. 12.8 μg/gCr; P < 0.0001); and had lower estimated glomerular filtration rate (mean: 43.3 vs. 57.3 mL/min/1.73m2; P < 0.0001) than those who did not. In the Cox regression analysis, urinary L-FABP levels, but not urinary albumin levels, were independently associated with the development of AKI (P < 0.0001) and AKI stage 2 or 3 (P = 0.02). Adding L-FABP to a baseline predictive model for AKI that included established risk factors further enhanced the C-index (P = 0.01), reclassification (P < 0.0001), and discrimination (P < 0.0001) beyond that of the baseline model alone. Tertiles of L-FABP levels were associated with increased AKI and AKI stage 2 or 3 rates (Table). Conclusions: Measurement of urinary L-FABP levels on admission could improve the prediction of AKI in patients hospitalized for worsening heart failure. [ABSTRACT FROM AUTHOR]

Introduction: Presepsin, a subtype of soluble CD14, is an inflammatory marker, which largely reflects monocyte activation and seems to be a precise diagnostic marker of sepsis. However, its clinical significance remains unclear in cardiovascular disease. This prospective study aimed to investigate the prognostic value of plasma presepsin levels for short-term mortality in patients with acute coronary syndrome (ACS). Methods: We examined 738 patients hospitalized to coronary care units (CCUs) for ACS and measured the baseline plasma presepsin levels at admission. Results: ST-segment elevation myocardial infarction was present in 48% of the patients, Killip class > II in 21%, diabetes in 36%, and prior myocardial infarction in 17%. Before CCUs admission, emergency percutaneous coronary intervention was performed in 55%, mechanical ventilation was required for respiratory insufficiency in 3.2%, and intraaortic balloon pumps were needed for hemodynamic instability in 13%. During 6 months after admission, 50 (6.8%) deaths occurred. Patients who died were older (mean: 73 vs. 67 years; P = 0.0001); had a higher prevalence of Killip class > II (50% vs. 19%; P < 0.0001); had higher levels of presepsin (median: 215 vs. 87 pg/mL; P < 0.0001), B-type natriuretic peptide (300 vs. 75 pg/mL; P < 0.0001), high-sensitivity troponin T (1440 vs. 240 pg/mL; P < 0.0001), and high-sensitivity C-reactive protein (9.0 vs. 1.3 mg/L; P < 0.0001); and had lower levels of estimated glomerular filtration rate (mean: 54 vs. 72 mL/min/1.73m2; P < 0.0001) and left ventricular ejection fraction (39% vs. 51%; P < 0.0001) than those of the survivors. In the multivariate Cox regression analysis, higher presepsin levels were independently associated with 6-month deaths (P = 0.002). Adding presepsin levels to a baseline model of established risk factors further enhanced reclassification (P = 0.003) and discrimination (P = 0.01) beyond that of the baseline model alone. Tertiles of presepsin levels were associated with higher mortality rates within 6 months after admission (Table). Conclusions: Presepsin levels at admission could improve the prediction of short-term mortality in patients with ACS. [ABSTRACT FROM AUTHOR]