Diagnostic Value and Prognostic Use of Presepsin Versus Procalcitonin in Sepsis

Background: Sepsis is a medical problem beyond belief despite the use of modern antibiotics and frequently updated guidelines on resuscitation therapies. It is at this crucial juncture where inflammatory biomarkers have been providing an incredible and easy way to detect sepsis. Various biomarkers have been used over the past decades in medicine to evaluate sepsis, each one better than the previous and having its own pros and cons. In this study, we assess the role of presepsin, which is a CD-14 polypeptide, and procalcitonin which has for some time been the inflammatory marker of choice in sepsis. This is the first study of presepsin as a sepsis biomarker in Indian adults. Methods: A prospective observational study was conducted in 48 patients who were diagnosed to have sepsis either on admission to the hospital or during their stay in hospital according to the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) guidelines during the period from October 2015 to January 2017, after fulfilling all inclusion and exclusion criteria. Efficacy of both inflammatory markers was studied from blood drawn from the patient at the same time, with the same prick. Results: A total of 48 patients were included in this study. The superiority of presepsin over procalcitonin was evident with presepsin having a sensitivity of 46.2 and specificity of 100 and procalcitonin having a sensitivity of 46.2 and specificity of 31.8. The P value of the presepsin results was significant at <0.001. Along with it, presepsin also proved to be a very reliable marker for 28-day mortality with all 12 patients in the presepsin positive group expiring (P value: <0.001). Receiver operating characteristic (ROC) curve was plotted to try and define an optimal normal value for presepsin in an Indian population and the value calculated was 93.71 with a sensitivity of 65.4 and a specificity of 68.2. Conclusion: This study shows the superiority of presepsin over procalcitonin as it has much better specificity and a similar sensitivity than procalcitonin and is a better indicator of 28-day mortality. The new cut off that we have postulated here for presepsin improves the efficiency of the inflammatory marker by increasing its sensitivity at the cost of decreasing its specificity slightly.