Diagnostic and prognostic value of presepsin (soluble CD14 subtype) in emergency patients with early sepsis using the new assay PATHFAST presepsin

Background: Presepsin (soluble CD14 subtype, sCD14-ST) is a circulating molecule fragment derived from soluble CD14 (sCD14) and serves as mediator of lipopolysaccharide response against infectious agents. Initial evidence suggested that presepsin may be beneficial as a sepsis marker. Methods: In 140 septic patients admitted to the emergency department and 119 healthy persons (control group), presepsin and procalcitonin levels were determined at admission and after 24 and 72 h. Primary endpoint was death within 30 days. The combined "major adverse event" (MAE) endpoint consisted of at least one of the primary or secondary endpoints (intensive care, mechanical ventilation or dialysis). Results: Mean values of presepsin were 159 pg/mL (90% CI: 148-171) in the control group and 2,563 pg/mL (90% CI: 1458-3669) in the patient group. The 30-day mortalities were 3.5%, 25% and 67% in patients with low-grade sepsis, severe sepsis and septic shock, respectively. In contrast to procalcitonin, presepsin values differed highly significantly between sepsis grades (p < 0.0001) and were comparable to the clinical scores. The mortality increased from the 1st to the 4th quartile of presepsin, from 2.7% to 39.4%. Presepsin demonstrated superior prognostic accuracy for 30-day risk of death. The area under the receiver operating characteristics curve was 0.878 (95% CI: 0.801-0.934) compared to 0.668 (95% CI: 0.570-0.757) and 0.815 (95% CI: 0.709-0.895) for procalcitonin and Acute Physiology and Chronic Health Evaluation II scores, respectively. During the first 72 h patients with MAEs showed significantly increasing presepsin values, whereas the values in patients without MAEs were decreasing. Conclusion: Presepsin demonstrated a strong relationship with disease severity and outcome. Presepsin values were related to the course of the disease. In contrast to PCT, presepsin provided more reliable prognosis and early prediction of 30-day mortality already at admission.