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Presepsin cut-off value for diagnosis of sepsis in patients with renal dysfunction

Presepsin is used as a marker for diagnosing sepsis, but its serum concentration is affected by renal function. We investigated the effect of the estimated glomerular filtration rate (eGFR) determined by creatinine on the diagnostic accuracy of presepsin to identify the optimal cut-off value in pati...

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Autores principales: Arakawa, Kimika, Saeki, Ayako, Ide, Reo, Matsushita, Yoshiteru
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9473387/
https://www.ncbi.nlm.nih.gov/pubmed/36103464
http://dx.doi.org/10.1371/journal.pone.0273930
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author Arakawa, Kimika
Saeki, Ayako
Ide, Reo
Matsushita, Yoshiteru
author_facet Arakawa, Kimika
Saeki, Ayako
Ide, Reo
Matsushita, Yoshiteru
author_sort Arakawa, Kimika
collection PubMed
description Presepsin is used as a marker for diagnosing sepsis, but its serum concentration is affected by renal function. We investigated the effect of the estimated glomerular filtration rate (eGFR) determined by creatinine on the diagnostic accuracy of presepsin to identify the optimal cut-off value in patients with renal dysfunction. A total of 834 patients aged ≥18 years with serum presepsin and creatinine measured on the same day over a period of 1 year were included. Sepsis was diagnosed in three ways: sepsis-1, sepsis-3, and clinical diagnosis (Sep-C). Presepsin showed a significant negative correlation with eGFR (r = −0.55, p<0.01), with median and interquartile ranges of presepsin values for patients in each eGFR category as follows: ≥90, 263 (169–460); ≥60–<90, 309 (205–578); ≥45–<60, 406 (279–683); ≥30–<45, 605 (379–1109); ≥15–<30, 1027 (675–1953); <15, 1977 (1199–3477); and on hemodialysis, 3964 (2343–6967). In receiver operating characteristic (ROC) analysis, the area under the curve (AUC) for sepsis-1 was the lowest (0.64 ± 0.02), while Sep-C (0.80± 0.03) and sepsis-3 (0.75 ± 0.03) were moderately accurate. Comparing AUCs after dividing patients into eGFR ≥60 and <60 showed that the AUC of Sep-C was lower in the eGFR ≥60 group, while the AUC of sepsis-3 was ≥ 0.7 in both groups. The following cut-offs were obtained by ROC analysis for sepsis-3: 466 pg/mL in the ≥60 group and 960 pg/mLin the < 60 group. Presepsin facilitated diagnosis sepsis based on sepsis-3 criteria regardless of renal function. We found that the optimal cut-offs for patients in this study were 500 pg/mL for eGFR ≥ 60 and 1000 pg/mL for < 60. However, future prospective diagnostic studies on sepsis-3 are needed to determine the cut-offs for patients with renal dysfunction.
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spelling pubmed-94733872022-09-15 Presepsin cut-off value for diagnosis of sepsis in patients with renal dysfunction Arakawa, Kimika Saeki, Ayako Ide, Reo Matsushita, Yoshiteru PLoS One Research Article Presepsin is used as a marker for diagnosing sepsis, but its serum concentration is affected by renal function. We investigated the effect of the estimated glomerular filtration rate (eGFR) determined by creatinine on the diagnostic accuracy of presepsin to identify the optimal cut-off value in patients with renal dysfunction. A total of 834 patients aged ≥18 years with serum presepsin and creatinine measured on the same day over a period of 1 year were included. Sepsis was diagnosed in three ways: sepsis-1, sepsis-3, and clinical diagnosis (Sep-C). Presepsin showed a significant negative correlation with eGFR (r = −0.55, p<0.01), with median and interquartile ranges of presepsin values for patients in each eGFR category as follows: ≥90, 263 (169–460); ≥60–<90, 309 (205–578); ≥45–<60, 406 (279–683); ≥30–<45, 605 (379–1109); ≥15–<30, 1027 (675–1953); <15, 1977 (1199–3477); and on hemodialysis, 3964 (2343–6967). In receiver operating characteristic (ROC) analysis, the area under the curve (AUC) for sepsis-1 was the lowest (0.64 ± 0.02), while Sep-C (0.80± 0.03) and sepsis-3 (0.75 ± 0.03) were moderately accurate. Comparing AUCs after dividing patients into eGFR ≥60 and <60 showed that the AUC of Sep-C was lower in the eGFR ≥60 group, while the AUC of sepsis-3 was ≥ 0.7 in both groups. The following cut-offs were obtained by ROC analysis for sepsis-3: 466 pg/mL in the ≥60 group and 960 pg/mLin the < 60 group. Presepsin facilitated diagnosis sepsis based on sepsis-3 criteria regardless of renal function. We found that the optimal cut-offs for patients in this study were 500 pg/mL for eGFR ≥ 60 and 1000 pg/mL for < 60. However, future prospective diagnostic studies on sepsis-3 are needed to determine the cut-offs for patients with renal dysfunction. Public Library of Science 2022-09-14 /pmc/articles/PMC9473387/ /pubmed/36103464 http://dx.doi.org/10.1371/journal.pone.0273930 Text en © 2022 Arakawa et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Arakawa, Kimika
Saeki, Ayako
Ide, Reo
Matsushita, Yoshiteru
Presepsin cut-off value for diagnosis of sepsis in patients with renal dysfunction
title Presepsin cut-off value for diagnosis of sepsis in patients with renal dysfunction
title_full Presepsin cut-off value for diagnosis of sepsis in patients with renal dysfunction
title_fullStr Presepsin cut-off value for diagnosis of sepsis in patients with renal dysfunction
title_full_unstemmed Presepsin cut-off value for diagnosis of sepsis in patients with renal dysfunction
title_short Presepsin cut-off value for diagnosis of sepsis in patients with renal dysfunction
title_sort presepsin cut-off value for diagnosis of sepsis in patients with renal dysfunction
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9473387/
https://www.ncbi.nlm.nih.gov/pubmed/36103464
http://dx.doi.org/10.1371/journal.pone.0273930
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