Validity of presepsin for the diagnosis and prognosis of sepsis in elderly patients admitted to the Intensive Care Unit.

BACKGROUND

Preliminary reports suggested that presepsin was a powerful biomarker for sepsis in a general population. However, presepsin levels change with age. This study aimed to investigate the diagnostic and prognostic value of presepsin among elderly patients with sepsis in the intensive care unit (ICU).

METHODS

A total of 142 elderly patients were enrolled and assorted into three groups: non-infection, infection, and sepsis. Blood samples were collected on days 1, 3 and 7 during the first week of ICU stay for presepsin measurement. Diagnostic and prognostic utilities were tested by receiver operating characteristic, cutoff levels, Kaplan Meier survival curves and hazard ratios.

RESULTS

The presepsin level on days 1 and 3 were significantly higher in sepsis compared with infection (P<0.01) and non-infection (P<0.01). The diagnostic area under the curve (AUC) of presepsin was comparable to that of procalcitonin (P>0.05) and higher than that of C-reactive protein or interleukin 6 (P<0.05) on days 1 and 3. In AUC and Kaplan-Meier survival curves, presepsin on day 3 showed a significant prognostic value for 30-day mortality but was not superior to other biomarkers.

CONCLUSIONS

The presepsin level was significantly higher in elderly patients with sepsis compared with the non-infection and infection groups. Presepsin has a reliable early diagnostic ability for sepsis comparable to that of PCT. However, it cannot be defined as a perfect biomarker for prognosis of 30-day mortality in elderly patients. An overall and continual assessment of all the clinical indexes for sepsis during the course of the disease is necessary.