The utility of presepsin in diagnosis and risk stratification for the emergency patients with sepsis

To evaluate the value of presepsin in diagnosis and risk stratification of septic patients in emergency department, and investigate the utility in differentiation of gram-positive and gram-negative bacterial infection. We enrolled 72 patients with sepsis and 23 nonbacterial patients with systemic inflammatory response syndrome (SIRS) who were admitted to the emergency department of Tianjin Medical University General Hospital. Meanwhile, 20 healthy volunteers were included. Plasma presepsin, serum PCT, C-reactive protein (CRP), lactate and white blood cells (WBC) were measured, and APACHE II score were calculated upon admission. The receiver-operating-characteristic curve (ROC) was computed and the area under the ROC curve was for evaluating the value to diagnose sepsis. Then the patients were grouped according to the result of culture and severity of sepsis. The levels of presepsin, PCT, CRP and WBC were apparently higher in sepsis patients than in nonbacterial SIRS group (P < 0.05). The levels of presepsin and the APACHEII score were demonstrated the significant difference among sepsis, severe sepsis and septic shock patients (P < 0.05). The area under the ROC curve of presepsin, PCT, CRP and WBC were 0.954, 0.874, 0.859 and 0.723 respectively. The cutoff of presepsin for discrimination of sepsis and nonbacterial infectious SIRS was determined to be 407 pg/ml, of which the clinical sensitivity and specificity were 98.6% and 82.6%, respectively. Moreover, presepsin was significantly different between gram-positive and gram-negative bacterial infection (P < 0.05). Presepsin was a promising biomarker for initially diagnosis and risk stratification of sepsis, and a potential marker to distinguish gram-positive and gram-negative bacterial infection.