title: Presepsin (Soluble CD14 Subtype): Reference Ranges of a New Sepsis Marker in Term and Preterm Neonates.
abstract: OBJECTIVE
  Presepsin (soluble CD14 subtype) has been shown to be beneficial as a sepsis marker in adults. Nevertheless, very few data are available in neonates. The aim of the present study was to determine reference ranges of presepsin in term and preterm neonates.
  
  
  METHODS
  Healthy term neonates and preterm neonates without clinical signs of infection admitted to the Neonatal Unit were consecutively enrolled. Presepsin concentrations in whole blood were measured using a point-of-care assay system located in the Unit. Demographic data, antenatal and perinatal variables commonly affecting C-reactive protein and procalcitonin values were considered.
  
  
  RESULTS
  Of the 684 neonates enrolled in the study, 484 (70.8%) were born at term and 200 (29.2%) were preterm (24-36 weeks' gestation). In term infants, presepsin median value was 603.5 pg/mL (interquartile range: 466.5-791 pg/mL; 5th and 95th centiles: 315 and 1178 pg/mL respectively). In preterm infants, presepsin median value was slightly higher, equal to 620 pg/mL (interquartile range: 503-864 pg/mL; 5th and 95th centiles: 352 and 1370 pg/mL respectively). The reference ranges of presepsin we determined were much higher than those seen in healthy adults. No correlation between presepsin levels and postnatal age was observed, as well as no significant difference was demonstrated in preterm neonates at different gestational ages. None of the variables analyzed affected presepsin levels at a clinical significant extent.
  
  
  CONCLUSIONS
  For the first time, this study provides reference ranges of presepsin in term and preterm neonates. Having reliable reference values is crucial for obtaining an adequate diagnostic accuracy. Based on our results, most variables commonly affecting C-reactive protein and procalcitonin values do not affect presepsin levels, which suggests that presepsin could be an effective sepsis marker. Further investigations in large groups of neonates with sepsis are needed to determine the diagnostic and prognostic value of this biomarker.
authors.affiliation: NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: Lorenza
authors.initials: L
authors.lastname: Pugni
authors.affiliation: NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Pietrasanta
authors.affiliation: Laboratory "GA Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Silvano
authors.initials: S
authors.lastname: Milani
authors.affiliation: Laboratory "GA Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Vener
authors.affiliation: NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ronchi
authors.affiliation: NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: Mariella
authors.initials: M
authors.lastname: Falbo
authors.affiliation: Microbiology Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Milena
authors.initials: M
authors.lastname: Arghittu
authors.affiliation: NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Mosca
mesh_terms: D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood* / Q000378:metabolism; D018950:Lipopolysaccharide Receptors / Q000097:blood* / Q000378:metabolism; D010446:Peptide Fragments / Q000097:blood*; D019095:Point-of-Care Systems; D011247:Pregnancy; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood; D012016:Reference Values; D018805:Sepsis / Q000097:blood*; D047929:Term Birth / Q000097:blood / Q000378:metabolism
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D018950:Lipopolysaccharide Receptors; D010446:Peptide Fragments; D011498:Protein Precursors; C000594167:presepsin protein, human; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide