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Presepsin teardown - pitfalls of biomarkers in the diagnosis and prognosis of bacterial infection in cirrhosis
- Source :
- World Journal of Gastroenterology
- Publication Year :
- 2016
- Publisher :
- Baishideng Publishing Group Inc, 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.
- Subjects :
- Liver Cirrhosis
Male
Cirrhosis
Time Factors
Lipopolysaccharide Receptors
Gastroenterology
Severity of Illness Index
0302 clinical medicine
Risk Factors
Odds Ratio
Organ failure
biology
General Medicine
Orvostudományok
Bacterial Infections
Middle Aged
Prognosis
Up-Regulation
C-Reactive Protein
030220 oncology & carcinogenesis
Predictive value of tests
Area Under Curve
030211 gastroenterology & hepatology
Female
Calcitonin
medicine.medical_specialty
Klinikai orvostudományok
03 medical and health sciences
Retrospective Study
Predictive Value of Tests
Internal medicine
Severity of illness
medicine
Humans
Mortality
Aged
Retrospective Studies
Chi-Square Distribution
business.industry
C-reactive protein
Presepsin
Reproducibility of Results
Retrospective cohort study
Odds ratio
medicine.disease
Peptide Fragments
Logistic Models
ROC Curve
biology.protein
Bacterial infection
business
Chi-squared distribution
Biomarkers
Subjects
Details
- Language :
- English
- ISSN :
- 22192840 and 10079327
- Volume :
- 22
- Issue :
- 41
- Database :
- OpenAIRE
- Journal :
- World Journal of Gastroenterology
- Accession number :
- edsair.doi.dedup.....fc2bc7a3b8d948803f10cfc518a255db