The significance of presepsin in chronic kidney disease with sepsis

Abstract

Abstract Background: CKD has a high global prevalence with a consistent estimated global CKD prevalence of between 11 to 13% with the majority stage 3. Patients with CKD undergoing hemodialysis have low immunity and are prone to sepsis. Presepsin is a highly specific biomarker for the early diagnosis of sepsis because presepsin is increased in the blood in the early phase of infection and may be a helpful and valuable biomarker in early diagnosis of sepsis. Therefore, presepsin may have application for the early diagnosis of sepsis in patients with CKD.Purpose This prospective study evaluated the diagnostic value of serum presepsin (soluble CD14-ST) levels for sepsis in chronic kidney disease (CKD) and the influence of undergoing hemodialysis on serum presepsin Methods: This study included 291 patients with CKD and 101 patients with normal renal function and sepsis. Presepsin levels were increased in patients with CKD with or without sepsis or hemodialysis compared to controls, and were highest in patients with CKD and sepsis undergoing hemodialysis. Results: Presepsin levels were similar in patients with CKD with sepsis and no hemodialysis and patients with normal renal function and sepsis, but these levels were lower than in patients with CKD without sepsis undergoing hemodialysis. Presepsin, procalcitonin (PCT) and C-reactive protein (CRP) levels had diagnostic value for sepsis; however, presepsin was a better predictor of sepsis than PCT or CRP in patients with CKD not undergoing hemodialysis. Presepsin level had limited diagnostic value for sepsis in patients with CKD undergoing hemodialysis. In CKD complicated with sepsis, presepsin level was significantly correlated with CRP level, Sequential Organ Failure Assessment score, partial pressure of oxygen and body temperature; there was no correlation between presepsin level and these indicators in CKD without sepsis. Conclusion: These findings suggest physicians should incorporate information on biomarkers with medical history, clinical symptoms, physical signs, and other tests related to sepsis for its diagnosis in patients with CKD undergoing hemodialysis. Presepsin was a better predictor of sepsis in patients with CKD not undergoing hemodialysis.