Presepsin teardown- pitfalls of biomarkers in the diagnosis and prognosis of bacterial infection in cirrhosis

作     者：Maria Papp Tamas Tornai Zsuzsanna Vitalis Istvan Tornai David Tornai Tamas Dinya Andrea Sumegi Peter Antal-Szalmas 

作者机构：Department of Internal Medicine Division of Gastroenterology University of Debrecen Faculty of Medicine Department of Laboratory Medicine University of Debrecen Faculty of Medicine Debrecen Institute of Surgery University of Debrecen Faculty of Medicine Vascular Biology Thrombosis and Haemostasis Research Group Hungarian Academy of Sciences 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2016年第22卷第41期

页      面：9172-9185页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：Supported by János Bólyai Research Scholarship of Hungarian Academy of Sciences,No.BO/00426/11 University of Debrecen and Research Grant of National Research,No.RH/885/2013 Development and Innovation Office,No.K115818/2015/1 

主　　题：Presepsin Cirrhosis Bacterial infection Organ failure Mortality 

摘      要：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 *** Present 34.7 of patients had bacterial infection. Presepsin levels were significantly higher in patients with infection than without(median, 1002 pg/m L vs 477 pg/m L, P 1206 pg/m L 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/m L compared to those with ≤ 1277 pg/m L(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 *** 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.