Impact of initial plasma presepsin level for clinical outcome in hospitalized patients with pneumonia

Potential Utility of Combined Presepsin and LDH Tracking for Predicting Therapeutic Efficacy of Steroid Pulse Therapy in Acute Exacerbation of Interstitial Lung Diseases: A Pilot Study

Background/Objectives: The usefulness of presepsin, which is released from macrophages, in acute exacerbation of interstitial lung diseases (AE-ILDs) is unknown. We aimed to investigate the utility of monitoring presepsin with other AE-ILD markers before and after steroid pulse therapy in AE-ILDs. Methods: This pilot single-center retrospective observational study involved 16 patients with AE-ILDs, including the AE of idiopathic pulmonary fibrosis and idiopathic nonspecific interstitial pneumonia and rapidly progressive connective tissue disease-associated ILD. Patients who survived 90 days were assigned to the survival group (n = 9). The remaining patients were classified in the non-survivor group (n = 7). To evaluate the therapeutic efficacy of steroid pulse therapy, specific serum markers were selected-presepsin, as a novel AE-ILD marker, and surfactant protein D, C-reactive protein, and lactate dehydrogenase (LDH), as classical AE-ILD markers. Results: Thirteen out of sixteen patients with AE-ILDs showed high presepsin levels (presepsin ≥ 470 pg/mL) before steroid pulse therapy. The post-/pre-presepsin ratio and the post-/pre-LDH ratio, calculated by dividing the presepsin and LDH levels after therapy by the levels before therapy, respectively, showed a positive correlation (r = 0.579, p = 0.021). As a result of this correlation, the post-/pre-presepsin-LDH index was created, obtained from the "post-/pre-presepsin ratio" multiplied by the "post-/pre-LDH ratio". In a receiver operating characteristic curve analysis for non-survival, the post-/pre-presepsin-LDH index showed good discrimination as a prognostic marker for a poor outcome (AUC: 0.873, 95% confidence interval: 0.655-0.999). Conclusions: Tracking presepsin and LDH simultaneously may be useful for determining treatment response to steroid pulse therapy in the clinical management of AE-ILDs.

Research progress of biomarkers in evaluating the severity and prognostic value of severe pneumonia in children

Pneumonia is a serious and common infectious disease in children. If not treated in time, it may develop into severe pneumonia. Severe pneumonia in children is mainly characterized by hypoxia and acidosis, often accompanied by various complications such as sepsis and multiple organ dysfunction. Severe pneumonia has a rapid onset and progression, and a high mortality rate. Biomarkers assist clinicians in the early diagnosis and treatment of patients by quickly and accurately identifying their conditions and prognostic risks. In this study, common clinical and novel biomarkers of severe pneumonia in children were reviewed, and the application value of biomarkers related to the severity and prognosis of severe pneumonia in children was evaluated to provide help for early identification and precise intervention by clinicians.

Novel approach exploring the correlation between presepsin and routine laboratory parameters using explainable artificial intelligence

Although presepsin, a crucial biomarker for the diagnosis and management of sepsis, has gained prominence in contemporary medical research, its relationship with routine laboratory parameters, including demographic data and hospital blood test data, remains underexplored. This study integrates machine learning with explainable artificial intelligence (XAI) to provide insights into the relationship between presepsin and these parameters. Advanced machine learning classifiers provide a multilateral view of data and play an important role in highlighting the interrelationships between presepsin and other parameters. XAI enhances analysis by ensuring transparency in the model's decisions, especially in selecting key parameters that significantly enhance classification accuracy. Utilizing XAI, this study successfully identified critical parameters that increased the predictive accuracy for sepsis patients, achieving a remarkable ROC AUC of 0.97 and an accuracy of 0.94. This breakthrough is possibly attributed to the comprehensive utilization of XAI in refining parameter selection, thus leading to these significant predictive metrics. The presence of missing data in datasets is another concern; this study addresses it by employing Extreme Gradient Boosting (XGBoost) to manage missing data, effectively mitigating potential biases while preserving both the accuracy and relevance of the results. The perspective of examining data from higher dimensions using machine learning transcends traditional observation and analysis. The findings of this study hold the potential to enhance patient diagnoses and treatment, underscoring the value of merging traditional research methods with advanced analytical tools.

Potential predictors of severe course and outcome of community-acquired pneumonia

Severe pneumonia is a condition with a high risk of death and mandatory hospitalization in the intensive care unit. The incidence of severe pneumonia has increased dramatically during the pandemic of new coronavirus infection. Timely diagnosis and early initiation of adequate treatment of severe pneumonia are crucial for improving survival of critically ill patients.

The aim of this review was to analyze published scientific research on molecular markers that allow to objectively assess the severity of pneumonia and to determine treatment tactics based on the predicted outcome upon admission to the hospital. A systematic search was conducted in the electronic databases PubMed, Medline, Web of Science for the period 2019 - 2022.

Conclusion. The review focuses on the prognostic role of a number of markers of immune response, vascular transformation, as well as angiotensin II and angiotensin converting enzyme-2. Further prospective studies of potential predictors of severe pneumonia will enable using marker molecules in a comprehensive clinical and laboratory diagnosis for early prediction of the hospitalized patient’s condition and expected outcome.

Prognostic Value of Plasma Presepsin and Pneumonia Severity Index in Patients with Community-Acquired Pneumonia in the Emergency Department

Background and Objectives: Presepsin (PSS) is an independent predictor for estimating disease severity and prognosis in septic patients. Few studies have reported the associations between plasma PSS and the severity and prognosis in patients with community-acquired pneumonia (CAP). We investigated whether a high plasma PSS level was associated with 30-day mortality in CAP patients. Materials and Methods: This retrospective single-center study was conducted in an emergency department. The PSS level was measured in 211 adult CAP patients admitted to the hospital and followed for up to 30 days. We recorded the pneumonia severity index (PSI) and the CURB-65 score. The primary outcome was death from any cause within 30 days. Results: The plasma PSS levels were significantly elevated in the high-risk group (PSI > 130) compared with the low- (PSI < 91) or moderate-risk groups (PSI 91−130). Forty-four patients (20.9%) died within 30 days of admission. Non-survivors had significantly higher plasma PSS levels than survivors among CAP patients: 1083 (697−1736) pg/mL vs. 385 (245−554) pg/mL (p < 0.001). The area under the curve (AUC) to predict 30-day mortality was highest for PSS (0.867), followed by procalcitonin (0.728) and lactate (0.616). The cutoff level of plasma PSS for 30-day mortality was >754 pg/mL. The combination of PSI and plasma PSS level improved the predictive ability for 30-day mortality (AUC = 0.892). Cox regression analysis showed that higher PSS levels (>754 pg/mL) and higher PSI (>126) were associated with 30-day mortality in CAP patients (hazard ratios of 19.472 and 6.375, respectively). Conclusion: Elevated plasma PSS is associated with severity and 30-day mortality in hospitalized CAP patients. Combining plasma PSS level and PSI could significantly improve the predictive ability of PSS for 30-day mortality.

Usefulness of monocyte distribution width and presepsin for early assessment of disease severity in COVID-19 patients

Early predictors of severe coronavirus disease 2019 (COVID-19) would identify patients requiring intensive care. Recently, the monocyte distribution width (MDW) and presepsin level have been used for the early diagnosis of sepsis. Here, we assessed the utility of MDW and presepsin for the early assessment of COVID-19 severity. Eighty-seven inpatients with confirmed COVID-19 were enrolled and divided into 3 groups by the type of respiratory support: (1) mechanical ventilation or high-flow nasal cannula oxygen therapy (MVHF-OT), (2) conventional oxygen therapy, and (3) no oxygen therapy. We measured the complete blood count; MDW; erythrocyte sedimentation rate; and the levels of presepsin, C-reactive protein, procalcitonin, lactate dehydrogenase, ferritin, Krebs von den Lungen-6 (KL-6), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) neutralizing antibody. Thirteen (14.9%) patients on MVHF-OT exhibited a significantly higher mortality and a longer hospital stay than did the others. The MDW and presepsin levels were significantly elevated on admission, and correlated with COVID-19 severity (both P < .001). Notably, only the MDW correlated significantly with symptoms in the no oxygen therapy group (P < .012). In the first week after admission, the MDW fell and no longer differed among the groups. The KL-6 level did not differ by disease severity at any time. Neutralizing antibodies were detected in 74 patients (91.4%) and the level of neutralization correlated significantly with COVID-19 severity (P < .001). The MDW and presepsin are useful indicators for early assessment of disease severity in COVID-19 patients.

COVID-19 related thrombosis: A mini-review

Introduction

COVID-19 associated VTE is a new disease entity with high morbidity and mortality. The aim of this paper is to review contemporary emerging literature on the incidence, pathophysiology, predictive prognostic indicators, and management consensus for Covid-19 related thrombotic complications, in particular DVT and PE.

Methods

A literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. All searches were done via PubMed. References of review articles were further screened according to the exclusion criteria.

Results

In total, 154 records were identified and 20 duplicates were removed. A final 68 articles were included in the qualitative analysis. COVID-19 related thrombosis can affect multiple organs of the body, presenting in the form of arterial or venous thrombosis such as ischemic stroke, myocardial infarction, mesenteric ischemia, limb ischemia, DVT, or PE. DVT and PE has an overall incidence of 6–26%, and severely ill COVID-19 patients have even higher incidence of thromboembolism. On the other hand, incidence of arterial thromboembolism is much lower with incidence of 0.7%–3.7%. D-dimer is found to be an independent risk factor, and IMPROVE score, Caprini score, and Padua score have all been used as predictors. International guidelines suggest the use of low molecular weight heparin (LMWH) or fondaparinux for prophylaxis of VTE, and therapeutic dosage of weight adjusted LMWH for treatment if confirmed diagnosis.

Conclusions

Contemporary rapidly evolving evidence shows that COVID-19 associated thrombosis was a novel clinical entity, especially in severely ill COVID-19 patients. There are multiple society-driven guidelines only, but without any level 1 evidence for management regimen. The ideal dose for prophylaxis is not established and may vary depending on balance of bleeding and thrombosis risk. The risk of bleeding may be increased in patients in intensive care unit.

Presepsin as a Predictive Biomarker of Severity in COVID-19: A Systematic Review

BACKGROUND

The aim of this review is to evaluate the global scientific literature on the utility of plasma presepsin (PSP) as a prognostic biomarker in a homogeneous group of coronavirus disease 2019 (COVID-19) positive cases.

DATA RETRIEVAL

A systematic review utilizing Medline (PubMed interface), LitCovid NLM, World Health Organization (WHO)-global literature on coronavirus disease, and EBSCO CINAHL Plus was undertaken. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) group guidelines. The quality of individual evidence and possible risk of bias were assessed using the Quality in Prognosis Studies (QUIPS) tool. A narrative synthesis-based conclusion was compiled.

RESULTS

A total of three articles passed through the predefined screening criteria and were included in the review. Methodological quality was evaluated to be acceptable. The aggregate study population was summed up to be 167 COVID-19 positive cases, who had undergone analysis of plasma PSP levels for the prediction of severity and mortality. Based on different PSP cutoffs utilized, a statistically significant association between PSP and COVID-19 severity was reported.

CONCLUSION

PSP appears as a promising prognostic biomarker of COVID-19 progression. As data are scarce on its utility, large cross-sectional studies are needed.

HOW TO CITE THIS ARTICLE

Ahmed S, Mansoor M, Shaikh MS, Siddiqui I. Presepsin as a Predictive Biomarker of Severity in COVID-19: A Systematic Review. Indian J Crit Care Med 2021;25(9):1051-1054.

Presepsin as a Diagnostic and Prognostic Biomarker in Sepsis

Sepsis is a condition characterized by high morbidity and mortality which is commonly encountered in an emergency and critical care setting. Despite a substantial body of research, the ideal biomarker for the diagnosis and prognostic stratification of septic patients remains unknown. This review aimed to summarize the publications referring to the validity of the biomarker presepsin when used for the detection, monitoring and prognosis in patients suffering with sepsis.

This work is a narrative review based on a PubMed/Medline search conducted in order to identify all relevant publications referring to the use of presepsin in sepsis. Search was not limited by year of publication so all articles archived in the database would be retrieved. No article from before 2010 was identified.

A total of 57 publications of the last decade were included, all of which support the use of presepsin as a biomarker for the assessment of septic patients. It has been used alone or in combination with commonly used biomarkers in the evaluation of patients with sepsis in settings such as the emergency department and the intensive care unit. It is useful in the initial workup of patients with suspected sepsis in the emergency setting and may be a predictive factor of mortality and the most severe complication of sepsis.

Presepsin seems to be a valuable tool for the laboratory workup of sepsis, especially when used in conjunction with other biomarkers and clinical rating scores with an established role in this population. Further research is needed to evaluate the clinical implications of utilizing presepsin measurements in the workup of sepsis.

Determining the factors affecting serum presepsin level and its diagnostic utility: A cross-sectional study

INTRODUCTION

This study aimed to identify factors affecting presepsin levels and to determine their diagnostic utility.

METHODS

This cross-sectional study was conducted at an outpatient clinic and emergency department at an acute care hospital in Japan between January 2015 and December 2017. We enrolled 1,840 consecutive outpatients with at least one measurement of serum presepsin, who were suspected of having bacterial infection. The outcome variables were bacterial infection, lower respiratory tract infection, urinary tract infection, cholangitis, and other infections diagnoses, based on the chart review. We collected blood analysis data on the patients' presepsin levels.

RESULTS

There was a significant association between presepsin level and the diagnosis of bacterial infection even when adjusted for age, sex, renal function, and biliary enzyme levels. An increase of 1 unit in the log of presepsin values resulted in a relative risk ratio of 1.71 (1.09-2.66), 2.1 (1.58-2.79), 2.93 (2.05-4.19), 4.7(2.90-7.61), and 2.41(1.70-3.43), for bacterial infection, lower respiratory tract infection, urinary tract infection, cholangitis, and other infections, respectively.

CONCLUSIONS

Presepsin showed a statistically significant increase in the diagnosis of bacterial infections (lower respiratory tract infections, urinary tract infections, cholangitis, and non-severe patients) in a community hospital setting. However, in patients with renal dysfunction, presepsin levels should be interpreted with caution.

Presepsin in risk stratification of SARS-CoV-2 patients

•

To evaluate in SARS-CoV-2 patients the behavior of presepsin .

•

To compare the informations provided with those of other inflammatory biomarkers.

•

To provide new biochemical informations in patients suffering from SARS-CoV-2.

Background

A severe form of pneumonia, is the leading complication of the respiratory Coronavirus disease 2019 (COVID-19), recently renamed SARS-CoV-2. Soluble cluster of differentiation (CD)14 subtype (sCD14-ST also termed presepsin PSP) is a regulatory factor that modulates immune responses by interacting with T and B cells, useful for early diagnosis, prognosis and risk stratification prediction.

Methods

In 75 consecutive patients suffering from COVID-19 microbiology proven infection, admitted to intensive care unit (ICU, n = 21, 28%) and/or in infectious disease ward (IW, n = 54, 72%), PSP (Pathfast, Mitsubishi, Japan) has been measured in addition to routine laboratory tests performed during the period of hospitalization (from January to March 2020).

Results

PSP demonstrates: -statistically significant higher values (Mann-Whitney test) in 6 patients died (median, IQR = 1046, 763–1240; vs 417, 281–678 ng/L, p < 0.05); -statistically significant but poor correlations with CRP (r = 0.59, p < 0.001), LDH (r = 0.52, p < 0.001) and PCT (r = 0.72, p < 0.001) measured at the same day; -a significant relationship between concentrations and ICU stay. In fact patients showing PSP values higher than 250 ng/L (cut-off for risk stratification) did stay in ICU for a significantly longer time (median 17 days, IQR 12–31; p < 0.001) than those exhibiting lower values (median 10 days, IQR 7–18).

Conclusions

The data obtained seems to demonstrate the role of PSP in providing prognostic information in COVID-19 patients, allowing to identify, during the early phase of the monitoring, the patients suffering from a more severe disease which will be hospitalized for a more long time.