Multivisceral Transplant Unit, Gastroenterology, Padova University Hospital, Padova, Italy.
Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padova University Hospital, Padova, Italy.
Clin Chem Lab Med. 2020 Oct 23;59(4):775-782. doi: 10.1515/cclm-2020-1212. Print 2021 Mar 26.
Serum biomarkers have suboptimal accuracy for the early diagnosis of bacterial infection (BI) in cirrhosis. The aim of the study was to evaluate the diagnostic and prognostic accuracy of presepsin (PSP) in a cohort of hospitalized patients with cirrhosis.
All adult cirrhotics admitted between 03.2016 and 06.2019 were consecutively evaluated. PSP was measured using chemiluminescent enzyme immunoassay, and its accuracy was compared with that of common biomarkers.
A total of 278 cirrhotic patients for a total of 448 hospitalizations were prospectively collected. Prevalence of BI at admission was 28.3%. Median (range) LogPSP in the whole cohort was 2.83 (2.48-3.19) ng/L, significantly higher in patients with BI than in patients without (p<0.001). For a cutoff value of 2.87 ng/L, LogPSP showed sensitivity, specificity and AUC-ROC of 0.66 (95% CI 0.57-0.74), 0.63 (95% CI 0.57-0.68) and 0.69 (95% CI 0.63-0.73), lower than that of C-reactive protein (p=0.002), but similar to procalcitonin (p=0.18) Patients with BI at hospitalization had higher probability of 28-day mortality (sub-hazard ratio [sHR] 2.65;95% CI 1.49-4.70; p=0.001). At multivariate Cox's regression analysis, LogPSP (sHR 2.4; 95% CI 1.22-4.82; p=0.01) together with age and severity of liver disease, was an independent predictor of short-term mortality.
PSP shows low diagnostic accuracy for BI in cirrhosis, but it is an independent predictor of short-term mortality. PSP may be a biomarker of systemic inflammation, commonly seen in end-stage liver disease.
血清生物标志物对肝硬化患者细菌感染（BI）的早期诊断准确性欠佳。本研究旨在评估降钙素原前肽（PSP）在肝硬化住院患者中的诊断和预后准确性。
连续评估了 2016 年 3 月至 2019 年 6 月间所有住院的成年肝硬化患者。采用化学发光酶免疫分析法检测 PSP，并将其准确性与常见生物标志物进行比较。
共前瞻性收集了 278 例肝硬化患者的 448 次住院记录。入院时 BI 的患病率为 28.3%。整个队列的中位（范围）LogPSP 为 2.83（2.48-3.19）ng/L，BI 患者的 LogPSP 明显高于非 BI 患者（p<0.001）。当 LogPSP 截断值为 2.87 ng/L 时，LogPSP 的敏感性、特异性和 AUC-ROC 分别为 0.66（95%CI 0.57-0.74）、0.63（95%CI 0.57-0.68）和 0.69（95%CI 0.63-0.73），低于 C 反应蛋白（p=0.002），但与降钙素原相似（p=0.18）。入院时患有 BI 的患者 28 天死亡率的可能性更高（亚危险比 [sHR] 2.65；95%CI 1.49-4.70；p=0.001）。多变量 Cox 回归分析显示，LogPSP（sHR 2.4；95%CI 1.22-4.82；p=0.01）与年龄和肝病严重程度一起，是短期死亡率的独立预测因子。
PSP 对肝硬化 BI 的诊断准确性较低，但它是短期死亡率的独立预测因子。PSP 可能是终末期肝病中常见的全身炎症的生物标志物。
