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Non-specific Laboratory Tests in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Presepsin is soluble CD14 (sCD14) [138–140] and is a new biomarker for sepsis [138–142] that performs similarly to PCT [140,143–146]. Importantly, initial levels of presepsin in CCU patients with sepsis have been shown to be a predictive of outcome in a number of comparative studies with PCT [144,147–150]. The story of presepsin begins with the original model for sepsis, which involved the immune response to endotoxin [151]. Innate immune cells are WBCs that mediate innate immunity; these cells include basophils, dendritic cells, eosinophils, Langerhans cells, mast cells, monocytes, macrophages, neutrophils, and natural killer cells [152]. Innate immune cells possess a variety of surface receptors that recognize pathogen-associated molecular patterns (PAMPs); PAMPs may be sugars, peptides, nucleic acids, or anionic polymers [153]. The most important PAMP receptors are toll-like receptors, which are a family of pattern recognition receptors that induce overlapping yet distinct patterns of gene expression that contribute to the inflammatory response [154]. When these toll-like receptors are engaged by a PAMP, innate immune cells such as macrophages produce proinflammatory cytokines [155]. However, macrophage toll-like receptors require CD14 to recognize certain PAMPs such as lipopolysaccharide (LPS) [157,160]. CD14 is a homodimer of a horseshoe-shaped protein, with a pocket for phospholipid; it is a key component of the innate immune response to LPS [156–160]. Moreover, CD14 has the ability to recognize other types of ligands, including peptidoglycan and muramyl dipeptide as well as other surface structures in both gram-positive and gram-negative bacteria [161–164]. After binding of ligands, CD14 expression on the cell surface membrane decreases owing to the cleavage of soluble types of CD14 [165,166]. It is one of these soluble types of CD14 (sCD14-ST) that is presepsin [138,142]. Presepsin is a 64-amino-acid structure that is now considered a regulatory factor and interacts directly with T and B cells [167–169]. Because presepsin is an emerging biomarker for sepsis, evaluations are ongoing. Initial results have been promising [150], and newer studies continue to support the potential value of presepsin as a biomarker for sepsis [170–173]. Several points should be made in terms of the use of such biomarkers. One is that, to date, there is not an ideal biomarker for identifying sepsis in the first few hours [174]; however, currently, presepsin appears to be the most promising biomarker for sepsis. Multimarker approaches that include multiple biomarkers have been used and appear to be promising [175–177]. Only one of these multimarker studies includes presepsin [177]. Finally, continued comparisons of biomarkers are needed as additional studies are published; such steps are being taken [178].
The value of biomarker-guided antibiotic therapy
Published in Expert Review of Molecular Diagnostics, 2020
Ellen Haag, Alexandra Molitor, Claudia Gregoriano, Beat Müller, Philipp Schuetz
Presepsin is an immunologic biomarker which, according to recently published data, serves as early indicator for the detection of different infections [133]. The biological function of presepsin is not yet well described, but it seems to be a regulatory molecule [134,135]. Presepsin can not be measured in non-infective individuals but increases in the early state of bacterial infections [134]. It might be helpful and a valuable biomarker in early diagnosis of sepsis, as it was found to have high sensitivity and specificity [136]. The diagnostic accuracy in differentiating sepsis from non-sepsis however is only moderate. Levels of presepsin and their change under antibiotic therapy may be an appropriate indicator in monitoring in sepsis therapy, as levels showed to increase in patients with positive blood cultures and inappropriate antibiotic therapy [137,138]. To date, however, there is a lack of large-scale trials showing that the measurement of presepsin improves patient management.
Comparative study between complete blood picture indices and presepsin as early prognostic markers in septic shock patients
Published in Egyptian Journal of Anaesthesia, 2020
Ahmed M. El Said, Akram M. Fayed, Ehab M. El-Reweny
The current study demonstrated that presepsin showed significant association with mortality on admission and day 3. In agreement, Masson et al. [27] reported that presepsin in decedents was higher significantly on first, second, and seventh days. Also, Carpio et al. [28] found that presepsin in non-survivors was higher significantly on admission and day 3. In addition, Behnes et al. [8] reported that presepsin was useful for prognosis on admission and third day. In survivors, presepsin level was higher on admission than day 3, whereas in non-survivors, it was higher on day 3 than admission. In agreement, Carpio et al. [28] reported that median presepsin level in survivors was higher on admission than after 72 h, whereas in non-survivors, it was higher after 72 h than admission.
Could presepsin be an alternative marker in the early diagnosis of sepsis in COVID-19?
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2022
Rasime Derya Güleç, Fatma Demet Arslan, Taner Çalışkan, Nimet Şenoǧlu, Nisel Yılmaz, Sabri Atalay, İbrahim Pirim
In addition to clinical parameters, biomarkers can help monitor ICU patients. A meta-analysis reported that presepsin may be a useful biomarker in the early diagnosis of sepsis, however, has a moderate diagnostic accuracy in distinguishing sepsis from non-sepsis [10]. The diagnostic accuracy of PCT and presepsin in detecting infection is similar. Both two tests are useful in the early diagnosis of sepsis and the risk assessment of mortality in critical adult patients [11]. Besides, patients in septic shock have higher presepsin levels compared to patients with sepsis [12].