PLACE OF PRESEPSIN IN THE SCREENING FOR INFECTIONS IN THE CRITICALLY ILL PATIENTS

Abstract

In the patients staying in the intensive care wards, it is often necessary to differentiate the cause of systemic inflammatory response and multiple organ failure (infectious and non-infectious cause), which is often impossible unless various biomarkers are used.The objective: to study the informativeness of presepsin versus traditional biomarkers (procalcitonin, C-reactive protein), to find benefits and drawbacks of these biomarkers when investigating the nature of the systemic inflammatory response in critical states of various etiology.Subjects and methods. The retrospective-prospective study trail was conducted. 95 patients were included into the trial, they all were admitted to intensive care wards with symptoms of systemic inflammatory response and multiple organ failure, assessed as 2 and more SOFA scores and who had their levels of procalcitonin, presepsin and C-reactive protein tested. In order to assess sensitivity and specificity of presepsin for diagnostics of infections in the patients with disorders of excretory function of the kidneys and those with neutropenia, and the patients after massive traumatic surgeries, the following categories of patients were prospectively included in the study: patients with chronic kidney disease receiving hemodialysis (n=17), those with oncohematological disorders (n=8), and patients undergoing cardiac surgery (n=20) with cardiopulmonary bypass and without it (of pump).Results. It was demonstrated that presepsin was more sensitive and specific for diagnostics of sepsis versus other investigated biomarkers. It was found out that in the patients with sepsis and disorders of excretory function of the kidneys, the level of presepsin (IU 10 876 (2 030; 15 972) was nearly 8 times higher than in the patients receiving no substitutive renal therapy with hemodialysis Patients with neutropenia (IU of white blood count ‒ 0.4 (0.3; 0.5) and infectious complications had the level of presepsin compatible with the one in the patients undergoing surgery with no neutropenia: IU of presepsin in the patients with local infection made 324 (191; 601) pg/ml, and in the patients with sepsis it made 3,176 (1,514‒4,837) pg/ml. During the peri-operative period, the changes in the biomarkers level in the patients undergoing cardiac surgery demonstrated that their level significantly increases in 12 hours after surgery versus pre-operative level, despite the absence of the systemic infection. And the fold of procalcitonin increase (22-fold rise) was much higher versus presepsin (3-fold rise). The tendency to normalization of presepsin level was observed in 24 hours, the fact of cardiopulmonary bypass provided no significant impact on the changes in presepsin level.Conclusion. As an infection biomarker, presepsin possesses high sensitivity and specificity. It can be used for diagnostics of infection in the patients with neutropenia and without it. But it should be noted that its level can be increased in case of a critical state not related to the development of infectious complications. When interpreting the obtained clinical data it is important to understand which mechanisms can cause the elevation of its level in blood in a certain situation. For the most difficult cases, the most adequate result can be obtained when the levels of different biomarkers are tested simultaneously.

Keywords

• systemic inflammation response
• sepsis
• infection biomarkers
• presepsin