Usefulness of Presepsin Concentrations for Differentiating Sepsis Severity

Objectives: Prompt identification and appropriate treatment of sepsis is crucial for better disease outcome. Different sepsis biomarkers are widely used for rapid diagnosis of sepsis. The diagnostic accuracy of presepsin, procalcitonin (PCT), and C-reactive protein (CRP) in discriminating sepsis severity and their relationship with the Sepsis-related Organ Failure Assessment (SOFA) score were investigated in this study. Methods: During two time periods, 100 septic patients from two university clinical centres were enrolled in the study. Sepsis stratification was done using new Sepsis-3 definitions. During the illness, biomarkers and the SOFA score were assessed four times. The presepsin was measured using a sandwich ELISA kit. To evaluate the changes in biomarker concentrations and SOFA score values during the illness and to estimate the differences between severity groups, a generalised linear mixed effects model was utilised. The correlation of biomarkers with SOFA score was investigated using multivariate analysis. Results: Patients with septic shock (n=34) had significantly higher presepsin concentrations on admission compared to patients with sepsis (n=66), mean ±SD: 128.5±47.6 ng/mL vs. 88.6±65.6 ng/mL, respectively (p<0.001). Concentrations of PCT and CRP did not differ significantly between sepsis severity groups. A strong correlation of presepsin with SOFA score was also found (p<0.0001). Conclusions: In the research groups, presepsin demonstrated an excellent diagnostic ability to distinguish septic shock from sepsis. PCT and CRP were unable to distinguish the severity of sepsis.