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Yamasaki T, Miyamoto Y, Goto T, Oda Y, Yano T, Taniguchi M, Shirasaka T. Removal characteristics of presepsin by operating conditions and hemofilter. J Artif Organs 2023:10.1007/s10047-023-01424-w. [PMID: 38051434 DOI: 10.1007/s10047-023-01424-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/03/2023] [Indexed: 12/07/2023]
Abstract
Presepsin, which is used as a biomarker for sepsis, is thought to be removed by dialysis, but the actual removal properties of dialysis are unknown. We investigated the presepsin removal properties of continuous hemodiafiltration using the high concentration of presepsin from human plasma drained by plasma exchange. Each solution in plasma exchange was connected to a continuous hemodiafiltration blood circuit and circulated at 4 conditions. The results show that presepsin was confirmed to be removed more efficiently in hemofiltration than in hemodialysis. In addition, when using a polymethylmethacrylate hemofilter for continuous hemodiafiltration, the lowest presepsin concentration is on the filtrate side, suggesting that the main removal mechanism is adsorption. Since presepsin has a molecular weight of 13,000, its removal efficiency is high by hemofiltration as per principle. In addition, since the main adsorption principle of polymethylmethacrylate hemofilter is hydrophobic bond, presepsin is considered to be adsorbed. Since presepsin is metabolized in the kidney, it is elevated in renal failure. In this paper, we confirmed that presepsin is eliminated by continuous hemodiafiltration not only in the kidney. Depending on the timing of presepsin measurement, there is a risk of missing the diagnosis of sepsis. Kidney function and continuous hemodiafiltration should be checked when measuring presepsin.
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Affiliation(s)
- Tatsumi Yamasaki
- Department of Medical Equipment Center, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake-Cho, Miyazaki-Shi, Miyazaki, 889-1692, Japan.
| | - Yasuto Miyamoto
- Department of Medical Equipment Center, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake-Cho, Miyazaki-Shi, Miyazaki, 889-1692, Japan
| | - Takayuki Goto
- Department of Medical Equipment Center, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake-Cho, Miyazaki-Shi, Miyazaki, 889-1692, Japan
| | - Yuuichi Oda
- Department of Medical Equipment Center, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake-Cho, Miyazaki-Shi, Miyazaki, 889-1692, Japan.
| | - Takeshi Yano
- Departments of Intensive Care, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake-Cho, Miyazaki-Shi, Miyazaki, 889-1692, Japan
| | - Masahiko Taniguchi
- Department of Medical Equipment Center, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake-Cho, Miyazaki-Shi, Miyazaki, 889-1692, Japan
- Departments of Intensive Care, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake-Cho, Miyazaki-Shi, Miyazaki, 889-1692, Japan
| | - Tetsuro Shirasaka
- Department of Anesthesiology, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake-Cho, Miyazaki-Shi, Miyazaki, 889-1692, Japan
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Combined Use of Presepsin and (1,3)-β-D-glucan as Biomarkers for Diagnosing Candida Sepsis and Monitoring the Effectiveness of Treatment in Critically Ill Patients. J Fungi (Basel) 2022; 8:jof8030308. [PMID: 35330311 PMCID: PMC8954802 DOI: 10.3390/jof8030308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/07/2022] [Accepted: 03/14/2022] [Indexed: 11/17/2022] Open
Abstract
New biomarker panel was developed and validated on 165 critically ill adult patients to enable a more accurate invasive candidiasis (IC) diagnosis. Serum levels of the panfungal biomarker (1,3)-β-D-glucan (BDG) and the inflammatory biomarkers C-reactive protein, presepsin (PSEP), and procalcitonin (PCT) were correlated with culture-confirmed candidemia or bacteremia in 58 and 107 patients, respectively. The diagnostic utility was evaluated in sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). BDG was the best marker for IC, achieving 96.6% sensitivity, 97.2% specificity, 94.9% PPV, and 98.1% NPV at a cut-off of 200 pg/mL (p ≤ 0.001). PSEP exhibited 100% sensitivity and 100% NPV at a cut-off of 700 pg/mL but had a lower PPV (36.5%) and low specificity (5.6%). Combined use of PSEP and BDG, thus, seems to be the most powerful laboratory approach for diagnosing IC. Furthermore, PSEP was more accurate for 28-day mortality prediction the area under the receiver operating characteristic curve (AUC = 0.74) than PCT (AUC = 0.31; PCT cut-off = 0.5 ng/mL). Finally, serum PSEP levels decreased significantly after only 14 days of echinocandin therapy (p = 0.0012). The probability of IC is almost 100% in critically ill adults with serum BDG and PSEP concentrations > 200 pg/mL and >700 pg/mL, respectively, defining a borderline between non-invasive superficial Candida colonization and IC.
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Kim CH, Kim EY. Prediction of Postoperative Sepsis Based on Changes in Presepsin Levels of Critically Ill Patients with Acute Kidney Injury after Abdominal Surgery. Diagnostics (Basel) 2021; 11:diagnostics11122321. [PMID: 34943556 PMCID: PMC8700401 DOI: 10.3390/diagnostics11122321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 12/29/2022] Open
Abstract
Presepsin (PSP) is a viable biomarker for the detection of bacterial infection, but it lacks accuracy when acute kidney injury (AKI) develops. Herein, we evaluated the diagnostic and prognostic value of PSP in predicting postoperative sepsis after abdominal surgery respective to the degree of AKI. A total of 311 patients who underwent abdominal surgery and were admitted to a surgical intensive care unit were enrolled and classified into non-AKI, mild-AKI (stage 1, stage 2 and stage 3 without renal replacement therapy (RRT)) and severe-AKI (stage 3 with RRT) group, according to the Kidney Disease Improving Global Outcomes criteria. In each group, PSP and other biomarkers were statistically analyzed between non-sepsis and postoperative sepsis at the admission (T0), 24 h (T1), 48 h (T2) and 72 h (T3) after surgery. In non-AKI and mild-AKI group, PSP levels were significantly higher in postoperative sepsis than non-sepsis group, whereas no difference was detected in the severe-AKI group. Cutoff values of PSP in the mild-AKI group for the prediction of postoperative sepsis were 544 pg/mL (AUC: 0.757, p < 0.001) at T0 and 458.5 pg/mL (AUC: 0.743, p < 0.001) at T1, significantly higher than in non-AKI group. In multivariate analysis, predictors of postoperative sepsis in the mild-AKI group were PSP at T2 (odds ratio (OR): 1.002, p = 0.044) and PSP at T3 (OR: 1.001, p = 0.049). PSP can be useful for predicting newly developed sepsis in patients with transient AKI after abdominal surgery with modified cutoff values.
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Affiliation(s)
| | - Eun Young Kim
- Correspondence: ; Tel.: +82-2-2258-2876; Fax: +82-2-595-2822
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Shiota J. A hemodialysis patient with Mycobacterium avium complex pericarditis in which remarkable presepsin elevation was not accompanied by procalcitonin elevation. RENAL REPLACEMENT THERAPY 2020. [DOI: 10.1186/s41100-020-00269-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The application of presepsin for diagnosing infections in hemodialysis (HD) patients has not been confirmed yet. In addition, whether presepsin can detect atypical mycobacterial infection or not remains unknown.
Case presentation
We describe the case of a 66-year-old male HD patient with pericardial tamponade. Mycobacterium avium complex (MAC) was identified from a culture of pericardial effusion. The patient showed a clinical improvement after approximately 1 year without the administration of antibiotics. Remarkably, high plasma presepsin values were observed without an increase in serum procalcitonin values. The patient’s presepsin values decreased after the treatment of MAC induced pericarditis.
Conclusions
We found a HD patient with mycobacterium avium complex pericarditis with remarkable presepsin elevation unaccompanied by PCT elevation.
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