Diagnostic and prognostic utility of presepsin for sepsis in very elderly patients in the emergency department

•Presepsin level and cut-off value in very elderly were lower than in younger patients.•Presepsin is a good diagnostic marker for sepsis in very elderly patients.•Presepsin, PCT, and qSOFA is the best modality for early sepsis diagnosis.•Presepsin could also prognosticate mortality secondary to seps...

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Veröffentlicht in:Clinica chimica acta 2020-11, Vol.510, p.723-732
Hauptverfasser: Ruangsomboon, Onlak, Panjaikaew, Phantakarn, Monsomboon, Apichaya, Chakorn, Tipa, Permpikul, Chairat, Limsuwat, Chok
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Sprache:eng
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Zusammenfassung:•Presepsin level and cut-off value in very elderly were lower than in younger patients.•Presepsin is a good diagnostic marker for sepsis in very elderly patients.•Presepsin, PCT, and qSOFA is the best modality for early sepsis diagnosis.•Presepsin could also prognosticate mortality secondary to sepsis.•Presepsin, PCT and an early warning score yielded the highest prognostic accuracy. Presepsin, a biomarker for sepsis diagnosis, has not been studied in very elderly population. The study aimed to evaluate the diagnostic and prognostic value of Presepsin in very elderly patients compared to point-of-care Procalcitonin (PCT), C-reactive protein (CRP), and early warning scores (EWSs). This study prospectively enrolled 250 patients aged at least 75 years old, presenting to the Emergency Department of Siriraj Hospital with suspected sepsis during September 2019 and January 2020. They were classified into three groups: non-sepsis, sepsis, and septic shock. Biomarkers and EWS values at admission were determined. PCT was analyzed with non-BRAHM method. Presepsin had valuable diagnostic utility for sepsis (AUC 0.792), comparable to PCT (AUC 0.751, p = 0.22) and CRP (AUC 0.767, p = 0.47). It also showed similar prognostic accuracy (AUC 0.683) with PCT (AUC 0.691, p = 0.68) and CRP (AUC 0.688, p = 0.85). The combination of Presepsin, PCT, and an EWS yielded the highest diagnostic accuracy for sepsis and septic shock and highest prognostic accuracy for 30-day mortality. Presepsin is a valuable diagnostic and prognostic biomarker for sepsis in very elderly emergency patients. The combination of Presepsin, PCT, and an EWS was the best modality for early sepsis diagnosis and prognostication.
ISSN:0009-8981
1873-3492
DOI:10.1016/j.cca.2020.09.014