title: Usefulness of presepsin in the diagnosis of sepsis in patients with or without acute kidney injury.
abstract: BACKGROUND
  Presepsin is useful for differentiating sepsis from non-infection related systemic inflammatory response syndrome. However, there are no studies investigating the usefulness of presepsin in diagnosing sepsis involving patients with acute kidney injury (AKI). The purpose of this study is to determine levels of blood presepsin in patients with or without sepsis and among non-AKI patients or patients with different degrees of AKI severity.
  
  
  METHODS
  This is a single center retrospective study. 247 patients admitted to the ICU between June 2010 and October 2012 were analyzed for their presepsin levels. We classified the patients into non-AKI and AKI according to the RIFLE (Risk, Injury, Failure, and Loss of kidney function and End-stage kidney disease or simply Loss and ESKD) criteria. We then sub-classified the patients in each group into either non-sepsis or sepsis sub-group and analyzed the accuracy of diagnosing sepsis based on their levels of presepsin.
  
  
  RESULTS
  The number of patients for each group was: non-AKI, 112; under AKI: Risk, 50; Injury, 36; Failure, 42; Loss and ESKD, 7. The levels of presepsin in sepsis groups were significantly higher than that in the non-sepsis group among the non-AKI, Risk and Injury patients (p < 0.0001, p < 0.01, p < 0.01, respectively). However, no significant difference in the level of presepsin between non-sepsis and sepsis groups among patients with Failure. In the receiver operating characteristic (ROC) analysis, the area under the curve (AUC) was 0.784 in the non-AKI group and 0.698 in the AKI comprising Risk, Injury and Failure groups. AUC value for non-AKI was not significantly different from that of AKI (p = 0.200). When 670 pg/mL was used as the cutoff value for presepsin, sensitivity and specificity were 70.3% and 81.3%, respectively. When 864 pg/mL was used as the cutoff value for presepsin, sensitivity and specificity were 71.4% and 63.8%, respectively.
  
  
  CONCLUSIONS
  Presepsin level can be a reliable indicator of sepsis not only among non-AKI patients but also patients with less severe forms of AKI. However, it may not be a reliable indicator of sepsis in patients with a more advanced form of AKI.
authors.affiliation: Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180 Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180 Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Ishikura
authors.affiliation: Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180 Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nishida
authors.affiliation: Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180 Japan.
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Kawano
authors.affiliation: Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180 Japan.
authors.forename: Rie
authors.initials: R
authors.lastname: Yuge
authors.affiliation: Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180 Japan.
authors.forename: Reiko
authors.initials: R
authors.lastname: Ichiki
authors.affiliation: Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180 Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Murai
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications; D007677:Kidney Function Tests; D018950:Lipopolysaccharide Receptors / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000097:blood*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D018950:Lipopolysaccharide Receptors; D010446:Peptide Fragments; C000594167:presepsin protein, human
keywords: Acute kidney injury; Diagnosis; Presepsin; RIFLE criteria; Sepsis