Presepsin teardown – pitfalls of biomarkers in the diagnosis and prognosis of bacterial infection in cirrhosis Papp M et al . Presepsin in cirrhosis

AIM: Bacterial infections are frequent complications in cirrhosis with significant mortality. Early laboratory diagnosis is essential but challenging. We aimed to evaluate the diagnostic and prognostic value of presepsin in cirrhosis associated bacterial infections. METHODS: 216 patients with cirrhosis were enrolled. At admission, presence of bacterial infections and level of plasma presepsin, serum CRP and PCT were evaluated. Patients were followed for three months to assess the possible association between presepsin level and short-term mortality. RESULTS: 34.7% of patients had bacterial infection. Presepsin levels were significantly higher in patients with infection than without (median, 1002 vs. 477 pg/mL, p<0.001), increasing with the severity of infection (organ failure[OF]Yes vs. No: 2358 vs. 710 pg/mL, p<0.001). Diagnostic accuracy of presepsin for severe infections was similar to PCT and superior to CRP (AUCROC: 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, PPV and NPV 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-day 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 and nor CRP were independent risk factor for 28-day 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. Papp M Presepsin in cirrhosis 6