Presepsin as a predictor of severe sepsis in urinary tract infection

Abstract Background Recently, presepsin is reported to be a biomarker for early diagnosis of sepsis and evaluation of prognosis in septic patients, but there are few reports about urinary-tract infections. The objective of this study is to evaluate whether presepsin is a recent marker for detecting severe sepsis, and whether it can predict the therapeutic course in UTI when compared with procalcitonin (PCT) and C-reactive protein (CRP), already used markers.Methods From April 2014 to December 2016, a total of 50 patients, who were admitted into Gunma university hospital with urinary-tract infections, were enrolled in this study. Vital signs, presepsin, PCT, CRP, white blood cell (WBC), causative diseases of urinary-tract infections and other data were evaluated at the enrollment, third and fifth days. The patients were divided into two groups; with (n=11) or without (n=39) septic shock at the enrollment day, and with (n=7) or without (n=43) sepsis at the fifth day, respectively. Presepsin was evaluated for systemic inflammatory response syndrome (SIRS) or septic shock. Results Concerning the enrollment day, there was no significant difference of presepsin between SIRS and non-SIRS groups (p=0.276). The median presepsin (pg/mL) was significantly higher in the septic shock group (p<0.001). Multivariate logistic regression analysis showed presepsin (≧ 500 pg/ml) was an independent risk factor associated with septic shock (p=0.007). ROC curve for diagnosing septic shock indicated an area under the curve (AUC) at 0.881 for presepsin (vs. 0.690, 0.583 and 0.527 for PCT, CRP and WBC, respectively). Concerning the 5th day after admission, the median presepsin of the enrollment day was significantly higher in SIRS groups than non-SIRS groups (p=0.006). On the other hand, PCT (≥ 2 ng/ml) of the enrollment day was an independent risk factor associated with SIRS. ROC curve for diagnosing sepsis at the fifth day indicated an AUC at 0.837 for PCT (vs. 0.817, 0.811 and 0.802 for presepsin, CRP and WBC, respectively).Conclusions This study shows that presepsin may be a good marker for diagnosis of severe patients who need vasopressor therapy at the data of admission, and PCT may be a good marker for predicting hard-to-treat cases in UTI.