The sCD14-ST predictive value in the development of adverse outcomes in operated colorectal cancer patients (diagnostic study).

The main aim was to analyze dynamic changes in the level of soluble CD14 subtype (sCD14-ST) in blood serum and assess it as a possible risk factor for the development of systemic inflammatory response syndrome, infectious and inflammatory complications, organ dysfunction, and mortality in operated colorectal cancer (CRC) patients. Materials and methods: For the period 2020-2021, 90 operated CRC patients were examined. Patients were divided into two groups: 1 - 50 patients operated on for CRC without acute bowel obstruction (ABO); 2 - 40 patients operated on for tumor ABO caused by CRC. To determine sCD14-ST by the ELISA (enzyme-linked immunosorbent assay) method, venous blood was taken 1 h before surgery and 72 h after it (third day). Results: sCD14-ST levels were higher in CRC patients with ABO, organ dysfunction, and dead patients. If the sCD14-ST level on the third day after surgery is greater than 520 pg/ml, the risk of a fatal outcome is 12.3 times higher than at its lower level [odds ratio (OR): 12.3, 95% CI: 2.34-64.20]. With the increase in the sCD14-ST level on the third day after surgery from baseline or its decrease by no more than 8.8 pg/ml, the risk of organ dysfunctions is 6.5 times higher than with its greater decline (OR: 6.5, 95% CI: 1.66-25.83). Conclusions: This study has demonstrated that in CRC patients, sCD14-ST can be used as a predictive criterion for the development of organ dysfunction and death. Significantly worse results and prognosis were observed in the patients with higher levels of sCD14-ST on the third day after surgery.

SCD14-ST and New Generation Inflammatory Biomarkers in the Prediction of COVID-19 Outcome.

Since no definitive cure for COVID-19 is available so far, one of the challenges against the disease is understanding the clinical features and the laboratory inflammatory markers that can differentiate among different severity grades of the disease. The aim of the present study is a comprehensive and longitudinal evaluation of SCD14-ST and other new inflammatory markers, as well as cytokine storm molecules and current inflammatory parameters, in order to define a panel of biomarkers that could be useful for a better prognostic prediction of COVID-19 mortality. SCD14-ST, as well as the inflammatory markers IL-6, IL-10, SuPAR and sRAGE, were measured in plasma-EDTA of ICU COVID-19 positive patients. In this longitudinal study, SCD14-ST resulted significantly higher in patients who eventually died compared to those who were discharged from the ICU. The results suggest that the new infection biomarker SCD14-ST, in addition to new generation inflammatory biomarkers, such as SuPAR, sRAGE and the cytokines IL-6 and IL-10, can be a useful prognostic tool associated with canonical inflammatory parameters, such as CRP, to predict SARS-CoV-2 outcome in ICU patients.

Presepsin (soluble CD14 subtype) as a risk factor for the development of infectious and inflammatory complications in operated colorectal cancer patients.

PURPOSE: In this pilot study the dynamic of presepsin (soluble CD14 subtype, sCD14-ST) in blood serum was assessed as a possible risk factor for the development of systemic inflammatory response syndrome (SIRS) and infectious and inflammatory complications in operated colorectal cancer patients. METHODS: To determine sCD14-ST by enzyme-linked immunosorbent assay method venous blood was taken 1 hour before surgery and 72 hours after it (3rd day). The presence of SIRS and organ dysfunctions (ODs) according to the Sequential Organ Failure Assessment scale were assessed. RESULTS: Thiry-six patients with colorectal cancer were enrolled in the study. sCD14-ST level before surgery was 269.8±103.1 pg/mL (interquartile range [IQR], 196.7-327.1 pg/mL). Despite the presepsin level on the 3rd day being higher (291.1±136.5 pg/mL; IQR, 181.2-395.5 pg/mL), there was no statistical significance in its dynamics (P=0.437). sCD14-ST value both before surgery and on the 3rd day after it was significantly higher in patients with bowel obstruction (P=0.038 and P=0.007). sCD14-ST level before surgery above 330 pg/mL showed an increase in the probability of complications, SIRS, and OD (odds ratio [OR], 5.5; 95% confidence interval [CI], 1.1-28.2; OR, 7.0; 95% CI, 1.3-36.7; and OR, 13.0; 95% CI, 1.1-147.8; respectively). Patients with OD had higher levels on the 3rd day after surgery (P=0.049). CONCLUSION: sCD14-ST level in operated colorectal cancer patients was much higher if they were admitted with complication like bowel obstruction. Higher preoperative levels of sCD14-ST increase the probability of postoperative complications, SIRS, and OD. Therefore, further studies with large sample size are needed.

Antibody-mediated soluble CD14 stabilization prevents agitation-induced increases in presepsin levels in blood component specimens.

Presepsin is a 13-kDa N-terminal glycoprotein of CD14. Previously, agitation-induced increases in presepsin levels have been reported; however, the mechanism remains poorly understood. In this study, we aimed to reveal the mechanism of presepsin increase. The agitated plasma or serum was separated using gel exclusion chromatography and analyzed by ELISA. The effect of an anti-CD14 antibody (F1024-1-3) was examined. We observed elevated presepsin levels in the agitated plasma and aggregated soluble CD14 (sCD14). However, treatment with F1024-1-3 before agitation prevented the aggregation and the increase in presepsin levels. Depletion of aggregated sCD14 decreased the presepsin levels. Our findings indicate that agitation induces the aggregation of sCD14 and triggers an increase in presepsin. Anti-CD14 antibody prevents an increases in presepsin.

The limits and potentials of presepsin in orthopaedic surgery: state of the art and future directions.

Presepsin, i.e. the soluble cluster of differentiation 14-SubType (sCD14-ST), is an emerging biomarker for the diagnosis and evaluation of sepsis and infection. In 2004, Yaegashi et al. originally described presepsin as a potential biomarker; since then, several studies have investigated the role of presepsin in different infectious conditions, including neonatal sepsis, severe acute pancreatitis, infections in patients with haematological malignancies, severe community-acquired pneumonia, pacemaker and implantable cardioverter-defibrillator (ICD) pocket infections, surgical site infections (SSIs) and periprosthetic joint infects (PJIs). Moreover, presepsin has been also studied in the risk stratification in cardiac surgery patients, and as a biomarker in the perioperative management of patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). This review aims to summarize the current knowledge about presepsin, focusing on the limits and potentials that the use of this biomarker could have in daily clinical practice. Presepsin is could be useful in daily clinical practice in orthopaedic surgery in the diagnosis and prevention of SSIs and PJIs. It is a cost-effective biomarker, but to improve its accuracy, it is important to carefully recalculate presepsin circulating values in patients with chronic kidney disease. However, further studies with larger patients' samples are needed to better validate the use of this biomarker in orthopaedics. In the future, synovial fluid presepsin might be a useful biomarker in the diagnosis of septic arthritis and PJIs.

Evaluation of the clinical diagnostic value of traditional inflammatory markers and novel biomarkers in intracellular bacterial bloodstream infections.

OBJECTIVES: The clinical symptoms of the patients with intracellular bacterial bloodstream infections (Intra-bac BSIs) are atypical, and no early and accurate diagnostic biomarkers exist, which can easily lead to misdiagnosis, inappropriate and delayed treatment. Therefore, it is imperative to find novel biomarkers to help clinical diagnosis of Intra-bac BSIs. The present study was initiated to evaluate the diagnostic values of traditional inflammatory biomarkers (PCT, WBC and NEU% in identifying the patients with Intra-bac BSIs, and to further explore into the possibility of using suPAR and sCD14-ST as novel biomarkers for Intra-bac BSIs. METHODS: A multi-center retrospective study was conducted in three teaching hospitals in Chongqing. A total of 146 cases with BSIs, including 73 cases with Intra-bac BSIs and 73 cases with extracellular bacterial BSIs (Extra-bac BSIs) were enrolled in the retrospective study. We then prospectively enrolled 34 patients with Intra-bac BSIs, 34 patients with Extra-bac BSIs, 34 patients with viral infection and with normal medical examination results as a control group for further detection of sCD14-ST and suPAR by ELISA. RESULTS: PCT levels, WBC counts and NEU% in patients with Intra-bac BSIs were not increased or minimally increased, they were significantly lower than that with Extra-bac BSIs (P < 0.05), especially those with the Brucella bacterial BSIs, demonstrated a respective negative rate of 84% and 92% for PCT and WBC counts. In the prospective study, the levels of suPAR and sCD14-ST in both the Intra-bac BSIs and the Extra-bac BSIs groups were significantly higher than those in the viral infection group and normal control group (P < 0.05). The areas under the curve (AUC) of Intra-bac BSIs were 0.830 for suPAR, and 0.855 for sCD14-ST. The sensitivity, specificity, Youden's index for suPAR and sCD14-ST were respectively 76.5%, 88.2%, 0.647 and 94.1%, 64.7%, 0.588. CONCLUSIONS: Our multi-center study demonstrated that while the traditional inflammatory markers such as PCT, WBC counts, NEU% could not be served as promising diagnostic markers for Intra-bac BSIs; CRP can help guide the diagnosis of Intra-bac BSIs; Both suPAR and sCD14-ST could be considered as novel diagnostic biomarkers for Intra-bac BSIs as they showed good diagnostic accuracies in Intra-bac BSIs, especially suPAR.

The novel early predictive marker presepsin for postoperative pancreatic fistula: A pilot study.

Postoperative pancreatic fistula (PF) is a major and serious complication that occurs after pancreaticoduodenectomy (PD). The aim of the current study was to evaluate the use of a novel biomarker, presepsin, for predicting clinically relevant postoperative pancreatic fistula (CR-POPF) after PD. A prospective pilot study was conducted using 30 consecutive patients who underwent PD. Risk factors and candidates for predictive biomarkers for CR-POPF were statistically analyzed. CR-POPF (grade B and C; determined according to the guidelines of the International Study Group of Pancreatic Fistula) occurred in 15 patients (50%). Univariate analysis revealed that certain underlying conditions, including non-pancreatic cancer, smaller pancreatic ducts and soft pancreas texture were significantly associated with CR-POPF (P=0.005, P=0.004 and P=0.014, respectively). Furthermore, on day 1 post surgery (POD1), white blood cell count (P=0.040), levels of serum amylase (P=0.002) and serum presepsin (P=0.012), and the concentration of presepsin in drainage fluid (P<0.001) were significantly increased in CR-POPF compared with non-CR-POPF cases. Receiver operating characteristic curve analyses revealed that, on POD1, serum amylase and the concentration of presepsin in drainage fluid had an area under the curve value exceeding 0.8. A multivariate logistic regression analysis revealed that a higher concentration of presepsin in the drainage fluid was an independent predictive marker for CR-POPF (odds ratio, 14.503; 95% confidence interval, 1.750-120.229; P=0.013). To the best of our knowledge, the present study demonstrated for the first time that presepsin concentration in drainage fluid is a useful marker of CR-POPF after PD.

Serum level of soluble CD14 subtype predicts long-term prognosis in sepsis patients with cardiac dysfunction.

BACKGROUND: Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection, and some sepsis patients will develop cardiac dysfunction. Sepsis-induced cardiac dysfunction (SICD) has been demonstrated to be a promising predictor of mortality, although the prediction of SICD itself remains unclear. Clinical studies have shown that soluble CD14 subtype (sCD14-ST) may be a useful predictor for sepsis. In this study, we aimed to evaluate the predictive value of sCD14-ST for SICD in patients with sepsis. METHODS: Patients with SICD from three intensive care units (ICUs) of three medical centers between January 2015 and December 2018 were enrolled. Clinical data and information were collected from hospital and clinic records. Blood samples at admission were collected and serum levels of sCD14-ST were tested. Patients were followed up for at least 1 year. Major adverse cardiovascular events (MACEs) were recorded. Echocardiography was repeated at the end of 1-year follow-up. RESULTS: A total of 117 patients were enrolled into the final analysis. During 1-year follow-up, MACEs occurred in 35 (29.9%) patients. Most MACEs occurred with 3 months after discharge. Univariate and multivariate analysis revealed that age (OR =1.5, 95% CI: 1.2-2.3, P=0.036), cardiac troponin T (cTnT) (OR =1.4, 95% CI: 1.2-2.1, P=0.027), creatine (Cr) (OR =1.6, 95% CI: 1.3-2.5, P=0.022), sequential organ failure assessment (SOFA) score (OR =1.7, 95% CI: 1.3-2.6, P=0.012), and soluble cluster of differentiation 14 subtype (sCD14-ST) (OR =1.9, 95% CI:1.4-3.1, P=0.015) were predictors for MACEs in patients with SICD at 1-year follow-up. Area under receiver operating curve (AUROC) of sCD14-ST to MACEs was 0.784, and the cutoff point was 748.3 µg/L with a sensitivity of 0.78 and a specificity of 0.74 respectively. Blood test at the end of 1-year follow-up revealed that patients with a lower sCD14-ST level had better lower Cr, N-terminal pro-brain natriuretic peptide (NT-proBNP) and higher systolic blood pressure (SBP) and left ventricular ejection fraction (LVEF). CONCLUSIONS: MACEs mainly occurred within 3 months after discharge in patients with SICD, and high baseline serum levels of sCD14-ST predicted poor prognosis in patients with SICD.

The accuracy assessment of presepsin (sCD14-ST) for mortality prediction in adult patients with sepsis and a head-to-head comparison to PCT: a meta-analysis.

Objective: The soluble cluster of differentiation 14 subtype (sCD14-ST) or presepsin has recently been identified as a promising biomarker in sepsis. The present meta-analysis is performed to assess the prognostic value of presepsin in septic patients. Further, we compare the prognostic performance between presepsin and procalcitonin (PCT) in predicting all-cause mortality in these patients. Methods: A systemic and comprehensive search was conducted in PubMed, Embase and Cochrane databases by using Exploded Medical Subject Headings and appropriate corresponding keywords. Studies were eligible if they assessed the prognostic value of presepsin in sepsis and provided sufficient information to construct a 2×2 contingency table. A bivariate meta-analysis model was used to calculate the pooled sensitivity, specificity, positive/negative likelihood ratios and diagnostic odds ratio. The Chi-square and I 2 index were used to assess the heterogeneity and inconsistency. The Deek's funnel plot asymmetry test was used to assess the likelihood of publication bias. Results: Nine publications, comprising 1,561 patients, were included in this study. The overall area under the receiver operating characteristic curve (AUROC) of presepsin was 0.77 (95% CI, 0.73-0.81) with a pooled prognostic sensitivity (SEN) and specificity (SPE) of 0.83 (95% CI, 0.72-0.90) and 0.69 (95% CI, 0.63-0.74), respectively. Additionally, the PLR, NLR and DOR of presepsin were 2.6 (95% CI, 2.1-3.3), 0.25 (95% CI, 0.15-0.44) and 10 (95% CI, 5-22), respectively. The AUROC of PCT was 0.81 (95% CI, 0.78-0.84) with a pooled SEN of 0.76 (95% CI, 0.55-0.89) and SPE of 0.74 (95% CI, 0.33-0.94). There is no statistically significant difference in the performance of pooled SEN and SPE between presepsin and PCT, with a p value of 0.39 and 0.71, respectively. Conclusions: Based on the results of this meta-analysis, both presepsin and PCT are promising biomarkers for the prognosis of mortality in sepsis.

The diagnostic accuracy of presepsin in neonatal sepsis: a meta-analysis.

There is growing evidence that presepsin is a promising biomarker in the diagnosis of sepsis in adults. The objective of our study is to investigate current evidence related to the diagnostic accuracy of presepsin in neonatal sepsis. To accomplish this, we searched the Medline (1966-2017), Scopus (2004-2017), Clinicaltrials.gov (2008-2017), EMBASE (1980-2017), Cochrane Central Register of Controlled Trials CENTRAL (1999-2017), and Google Scholar (2004-2017) databases. Eleven studies were included in the present meta-analysis, with a total number of 783 neonates. The pooled sensitivity of serum presepsin for the prediction of neonatal sepsis was 0.91 (95% CI [0.87-0.93]) and the pooled specificity was 0.91 (95% CI [0.88-0.94]). The diagnostic odds ratio was 170.28 (95% CI [51.13-567.11]) and the area under the curve (AUC) was 0.9751 (SE 0.0117). Head-to-head comparison with AUC values of C-reactive protein (0.9748 vs. 0.8580) and procalcitonin (0.9596 vs. 0.7831) revealed that presepsin was more sensitive in detecting neonatal sepsis. CONCLUSION: Current evidence support the use of presepsin in the early neonatal period in high-risk populations as its diagnostic accuracy seems to be high in detecting neonatal sepsis. What is known: • Neonatal sepsis is a leading cause of morbidity and mortality. • Current laboratory tests cannot accurately discriminate endangered neonates. What is new: • The diagnostic odds ratio of presepsin is 170.28 and the area under the curve is 0.9751. • According to our meta-analysis, presepsin is a useful protein that may help clinicians identify neonates at risk.

Effects of Shuxuening Injection on Lac, Presepsin and NOS levels in sepsis patients / 中成药

AIM To investigate the effects of Shuxuening Injection (Ginkgo biloba leaf extract) on serum lactic acid (Lac),soluble CD14-st (Presepsin) and nitric oxide synthase (NOS) levels in sepsis patients.METHODS One hundred and eight patients with sepsis treated by routine treatment in our hospital from Jan.2014 to Oct.2016 were randomly divided into two groups,control group and Shuxuening group (therapy group).Two weeks were one therapeutic course.Before the treatment (the onset of patients within 3 hours),at 6 hours and 5 days after the treatment,Lac and Presepsin levels were detected,and the changes of nitric oxide (NO),NOS,inducible nitric oxide synthase (iNOS) and sequential organ failure assessment (SOFA) score were observed.Incidence of major adverse cardiac events (MACE) and 28-day survival were recorded at the same time.RESULTS Before the treatment,there were no significant differences in SOFA score and the levels of Lac,Presepsin,NO,NOS and iNOS between the two groups (P ＞ 0.05).Six hours after the treatment,the levels of Lac and Presepsin in the therapy group were lower than those in the control group (P ＜ 0.05),both the two groups had lower levels of Lac and Presepsin than those before the treatment (P ＜ 0.05);five days after the treatment,the levels of Lac and Presepsin in the two groups were lower than those at 6 hours after the treatment (P ＜ 0.05),the levels of Lac and Presepsin in the therapy group were lower than those in the control group (P ＜ 0.05).The SOFA score,NO,NOS and iNOS levels after the treatment in the therapy group were lower than those in the control group (P ＜ 0.05).The levels of Lac and Presepsin in sepsis patients were positively correlated with SOFA score (r =0.245,0.261,P =0.011,0.006).The patients in the therapy group had lower incidence of MACE and 28-day mortality rate than those in the control group (P ＜ 0.05).CONCLUSION The therapeutic effect of Shuxuening Injection combined with routine treatment on sepsis patients is superior to that of routine treatment,which can improve the prognosis of patients to a certain extent.

The predictive value of serum presepsin (sCD14-ST) for myocardial depression in septic patients / 中华传染病杂志

Objective To evaluate the predictive value of serum presepsin (sCD14-ST) for septic myocardial depression (SMD) in patients with severe sepsis or septic shock.Methods This was a prospective cohort study.A total of 84 patients with severe sepsis or septic shock were monitored by pulse indicator continuous cardiac output (PiCCO) system and divided into myocardial depression group (cardiac function index [CFI]0.05).There were 24 cases died in myocardial depression group.The mortality of myocardial depression group was significantly higher than that of non-depression group (64.9% vs 42.6%, χ2=4.132, P =0.042).The serum levels of sCD14-ST at day 1 and day 3 in myocardial depression group were significantly higher than those in non-myocardial depression group (both P<0.01).sCD14-ST levels in both groups showed downtrend.The serum level of sCD14-ST in non-survival group was significantly higher than that in survival group (P<0.01).Conclusions Myocardial depression is common in patients with severe sepsis and septic shock.High serum level of sCD14-ST is correlated with myocardial depression to some extent, but not an independent predictor.The combination of sCD4-ST, BNP and TNF-α can improve the predictive value for myocardial depression.

Effects of Shuxuening Injection on Lac, Presepsin and NOS levels in sepsis patients / 中成药

AIM To investigate the effects of Shuxuening Injection (Ginkgo biloba leaf extract) on serum lactic acid (Lac),soluble CD14-st (Presepsin) and nitric oxide synthase (NOS) levels in sepsis patients.METHODS One hundred and eight patients with sepsis treated by routine treatment in our hospital from Jan.2014 to Oct.2016 were randomly divided into two groups,control group and Shuxuening group (therapy group).Two weeks were one therapeutic course.Before the treatment (the onset of patients within 3 hours),at 6 hours and 5 days after the treatment,Lac and Presepsin levels were detected,and the changes of nitric oxide (NO),NOS,inducible nitric oxide synthase (iNOS) and sequential organ failure assessment (SOFA) score were observed.Incidence of major adverse cardiac events (MACE) and 28-day survival were recorded at the same time.RESULTS Before the treatment,there were no significant differences in SOFA score and the levels of Lac,Presepsin,NO,NOS and iNOS between the two groups (P ＞ 0.05).Six hours after the treatment,the levels of Lac and Presepsin in the therapy group were lower than those in the control group (P ＜ 0.05),both the two groups had lower levels of Lac and Presepsin than those before the treatment (P ＜ 0.05);five days after the treatment,the levels of Lac and Presepsin in the two groups were lower than those at 6 hours after the treatment (P ＜ 0.05),the levels of Lac and Presepsin in the therapy group were lower than those in the control group (P ＜ 0.05).The SOFA score,NO,NOS and iNOS levels after the treatment in the therapy group were lower than those in the control group (P ＜ 0.05).The levels of Lac and Presepsin in sepsis patients were positively correlated with SOFA score (r =0.245,0.261,P =0.011,0.006).The patients in the therapy group had lower incidence of MACE and 28-day mortality rate than those in the control group (P ＜ 0.05).CONCLUSION The therapeutic effect of Shuxuening Injection combined with routine treatment on sepsis patients is superior to that of routine treatment,which can improve the prognosis of patients to a certain extent.

The effect of soluble CD14-st on the assessment and prognosis of patients with acute paraquat ;poisoning / 中华急诊医学杂志

Objective To investigate the relationship between soluble CD14-st (Presepsin)and assessment,prognosis in patients with acute paraquat poisoning (APP).Methods A total of 82 patients with APP treated in Emergency Department of Harrison International Peace Hospital Affiliated to Hebei Medical University from January 2013 to January 2016 were divied into three groups:mild poisoning group (n =20),moderate poisoning group (n =36)and severe poisoning group (n =26).According to the outcomes,patients were divided into survivor group (n =28)and non-survivor group (n =54).Another 50 healthy subjects were selected as control group.In control group,samples of 3 mL venous blood from 50 healthy subjects were collected for laboratory examination.Samoles of 10 mL venous blood from all patients were collected before and 72 hours,7 days after treatment to detect presepsin,C reactive protein (CRP), tumor necrosis factor α(TNF-α),interleukin-6 (IL-6)and interleukin-10 (IL-10).Before and 72 hours, 7 days after treatment,the change of Acute physiology and chronic health evaluation (APACHE)Ⅱscore and the outcomes in 28 days were observed.The variance analysis of repeated measures was used for comparison among multiple groups,and the t test was used to compare changes of detected biomarkers between two groups,and the outcomes in 28 days between two groups were compared with chi square test. Pearson correlation test was used to analyze the correlation between Presepsin in patients with APP and the survival rate.Results APACHE Ⅱ scores and the serum level of prespsin,CRP,TNF-α,IL-6 at admission and 72 hours,7 days after treatment in three poisoning groups were significantly increased compared with control group,IL-10 were decreased compared with control group (P <0.05 ),and there were significant differences in those biomarkers between moderate group and mild group,and between severe group and mild group,moderate group (P <0.05).At admission,72 h,7 d after admission,APACHEⅡscore and the serum levels of presepsin,CRP,TNF-α,IL-6 in non-survivor group were higher than those in survivor group,and IL-10 in non-survivor was lower than that in survivor group (P <0.05).The mortality rates of these 3 groups were 25.00%,69.44% and 92.31%,demonstrating significant differences among three groups (P <0.05).The AUCs were 0.862 and 0.731 for presepsin and APACHEⅡscore respectively at admission.The predictive capability of presepsin for 28-day mortality was superior over that of APACHEⅡscore (P <0.05).The level of serum presepsin in patients with APP was negatively correlated with the survival rate (r =-0.285,P =0.009).Conclusions The detection of prespsin has important clinical value in the severity assessment and prognosis in patients with APP.It is an important guidance for early therapeutic strategy.

The accuracy of presepsin for the diagnosis of sepsis from SIRS: a systematic review and meta-analysis.

BACKGROUND: Sepsis is a common condition that has a high mortality and morbidity that need prompt diagnosis and treatment. Biomarkers like Soluble CD14 subtype (sCD14-ST, presepsin) may be useful in identifying patients with sepsis and its diagnostic superiority has been confirmed by several preliminary studies. The aim of this study was systematically and quantitatively to evaluate the value of presepsin for the diagnosis of sepsis through the method of meta-analysis. METHODS: Four major databases, including MEDLINE, EMBASE, ISI Web of Knowledge, and the Cochrane Library were systematically searched from inception to March 2015. Two investigators conducted the processes of literature search, study selection, data extraction, and quality evaluation independently. And the original data were extracted from all eligible individual studies to construct two-by-two tables. RESULTS: A total of eight studies comprising 1757 patients were included in this meta-analysis. The pooled sensitivity, specificity, and diagnostic odds ratio were 0.77 (95 % confidence interval [CI]: 0.75-0.80), 0.73 (95 % CI 0.69-0.77), and 14.25 (95 % CI 8.66-23.42), respectively. The summary receiver operating characteristic curve (SROC) area under the curve (AUC) was 0.8598. The subgroup analysis based on excluding the outliers showed that the pooled sensitivity and specificity were 0.85 (95 % CI 0.81-0.89) and 0.65 (95 % CI 0.59-0.70), respectively. The AUC was 0.8213 with no significant heterogeneity. CONCLUSIONS: Presepsin has moderate diagnostic capacity for the detection of sepsis. Further research of presepsin is needed before widespread use in emergency department. And presepsin in combination with other laboratory biomarkers in diagnosing sepsis may be the focus of future studies.

Presepsin (sCD14-ST), an innate immune response marker in sepsis.

Innate immunity is the first barrier to fight off bacteria, and partly relies on the engagement of the membrane coreceptor CD14. A product of cleavage of CD14, the soluble subtype of CD14 (sCD14-ST) or presepsin, is released in circulation after activation of defense mechanisms. Presepsin can be detected by biochemical methods and therefore appears as an emergent biomarker of infection. Here we present the rationale for presepsin development and recent data supporting its use at bedside. Presepsin may be worthwhile for early diagnosis and prognostic assessment of patients with systemic infections. This biomarker shows high specificity, and results from experimental and clinical studies are reinforcing the proof of concept. Performances place presepsin at the level of PCT who is used as a comparator. Biomarkers of infection are futile to diagnose infection with direct access to bacteria (as urinary tract infection, meningitis), but their use can be advocated to ascertain unclear diagnosis. Future developments of presepsin will probably use clinical models with a Bayesian approach to ascertain the additional value of the biomarker at bedside.

Diagnostic and prognostic value of presepsin in preterm deliveries.

PROBLEM: To evaluate the association between serum presepsin (soluble CD14 antigen subtype, sCD14-ST) levels soon after the appearance of signs of preterm delivery and preterm delivery within 48 h, before the 34th and 37th gestational weeks and the possible additional value of concurrently evaluated ultrasound vaginal cervicometry with serum presepsin measurement. METHODOLOGY: A total of 60 females were included. Serum presepsin was measured by a chemiluminescent immunoassay. Sonographic evaluation of cervical length in all females was conducted by transvaginal ultrasound. RESULTS: Patients who delivered within 48 h after analysis showed significantly higher presepsin concentrations compared to females with later deliveries. Higher presepsin was proven also for deliveries before/after weeks 34 and 37. A combined finding of cervical length shortening below 18 mm and presepsin level increasing above 623.5 pg/mL could point to the significantly high risk of preterm delivery. CONCLUSION: Elevated maternal serum concentration of sCD14-ST could be an independent and relevant risk factor for preterm delivery.

Role of Presepsin (sCD14-ST) and the CURB65 scoring system in predicting severity and outcome of community-acquired pneumonia in an emergency department.

INTRODUCTION: CD14 is one of the leukocyte differentiation antigens, and is present in macrophages, monocytes, granulocytes and their cell membranes. Presepsin, namely soluble CD14-subtype (sCD14-ST) is produced by circulating plasma proteases activating cleavage of soluble CD14 (sCD14). The aim of this study is to investigate the role of Presepsin and the CURB65 scoring system in the evaluation of severity and outcome of CAP in an ED. METHOD: A prospective, observational study was performed in an ED of an university teaching hospital from November 2011 to October 2012. A total of 359 patients with CAP and 214 patients with severe CAP (SCAP) were consecutively enrolled. Plasma Presepsin, lactate, serum PCT levels and leukocyte counts were measured and CURB65 score were calculated at admission enrollment. RESULT: Plasma Presepsin levels were significantly higher in SCAP patients than in CAP patients (P < 0.0001), increasing correspondingly with the enhancement of CURB65 score. Patients with ARDS or DIC had obviously higher plasma Presepsin levels than those without ARDS or DIC (all P < 0.0001), and plasma Presepsin levels were significantly higher in non-survivors than in survivors at 28-day follow-up. In logistic regression analysis, CURB65 score was the independent predictor of ARDS, and Presepsin was the independent predictor of DIC, and Presepsin and CURB65 score were both the independent predictors of 28-day mortality. The AUCs showed Presepsin in combination with CURB65 score in predicting ARDS, SCAP and 28-day mortality was superior to Presepsin or CURB65 score alone ( all P < 0.01), Presepsin was better than CURB65 score and leukocyte in predicting DIC ( P < 0.01). CONCLUSION: Presepsin is a valuable biomarker in predicting severity and outcome in CAP patients in the ED and Presepsin in combination with CURB65 score significantly enhanced the predictive accuracy.