Abstract
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 hemodialysis on serum presepsin. 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 with the controls, and were the highest in patients with CKD and sepsis undergoing hemodialysis. The findings were as follows: i) CKD patients with or without sepsis had higher presepsin levels than the healthy controls (P<0.01); ii) the level of presepsin in CKD patients with or without hemodialysis treatment was higher than that in the healthy control group, and presepsin levels in CKD patients with sepsis were higher than those in CKD patients without sepsis (P<0.05); iii) for CKD patients with sepsis, the presepsin level after hemodialysis was significantly higher than that in patients without hemodialysis; iv) without hemodialysis treatment, the sensitivity and specificity of presepsin in identifying CKD with sepsis were 90.2 and 83.9%, respectively, those of procalcitonin (PCT) were 83.9 and 75.8%, respectively, and those of C-reactive protein (CRP) were 75.6 and 75.8%, respectively; v) when CKD patients were undergoing hemodialysis,presepsin identify CKD merger sepsis sensitivity, specificity of 30.5 and 99.2% respectively. The sensitivity and specificity of PCT in the differential diagnosis of CKD with sepsis were 84.8 and 82.7%, respectively. CRP had a sensitivity of 78% and a specificity of 82.4% in the differential diagnosis of CKD complicated with sepsis. Presepsin, PCT and 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. These findings suggested that 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. Presepsinwas a better predictor of sepsis in patients with CKD not undergoing hemodialysis.