title: Presepsin teardown - pitfalls of biomarkers in the diagnosis and prognosis of bacterial infection in cirrhosis.
abstract: OBJECTIVE
  To evaluate the diagnostic and prognostic value of presepsin in cirrhosis-associated bacterial infections.
  
  
  METHODS
  Two hundred and sixteen patients with cirrhosis were enrolled. At admission, the presence of bacterial infections and level of plasma presepsin, serum C-reactive protein (CRP) and procalcitonin (PCT) were evaluated. Patients were followed for three months to assess the possible association between presepsin level and short-term mortality.
  
  
  RESULTS
  Present 34.7 of patients had bacterial infection. Presepsin levels were significantly higher in patients with infection than without (median, 1002 pg/mLvs477 pg/mL,P< 0.001), increasing with the severity of infection [organ failure (OF): YesvsNo, 2358 pg/mLvs710 pg/mL,P< 0.001]. Diagnostic accuracy of presepsin for severe infections was similar to PCT and superior to CRP (AUC-ROC: 0.85, 0.85 and 0.66, respectively,P= NS for presepsinvsPCT andP< 0.01 for presepsinvsCRP). At the optimal cut-off value of presepsin > 1206 pg/mL sensitivity, specificity, positive predictive values and negative predictive values were as follows: 87.5%, 74.5%, 61.8% and 92.7%. The accuracy of presepsin, however, decreased in advanced stage of the disease or in the presence of renal failure, most probably because of the significantly elevated presepsin levels in non-infected patients. 28-d mortality rate was higher among patients with > 1277 pg/mL compared to those with ≤ 1277 pg/mL (46.9%vs11.6%,P< 0.001). In a binary logistic regression analysis, however, only PCT (OR = 1.81, 95%CI: 1.09-3.01,P= 0.022) but neither presepsin nor CRP were independent risk factor for 28-d mortality after adjusting with MELD score and leukocyte count.
  
  
  CONCLUSIONS
  Presepsin is a valuable new biomarker for defining severe infections in cirrhosis, proving same efficacy as PCT. However, it is not a useful marker of short-term mortality.
authors.affiliation: Maria Papp, Tamas Tornai, Zsuzsanna Vitalis, Istvan Tornai, Department of Internal Medicine, Division of Gastroenterology, University of Debrecen, Faculty of Medicine, H-4032 Debrecen, Hungary.
authors.forename: Maria
authors.initials: M
authors.lastname: Papp
authors.affiliation: Maria Papp, Tamas Tornai, Zsuzsanna Vitalis, Istvan Tornai, Department of Internal Medicine, Division of Gastroenterology, University of Debrecen, Faculty of Medicine, H-4032 Debrecen, Hungary.
authors.forename: Tamas
authors.initials: T
authors.lastname: Tornai
authors.affiliation: Maria Papp, Tamas Tornai, Zsuzsanna Vitalis, Istvan Tornai, Department of Internal Medicine, Division of Gastroenterology, University of Debrecen, Faculty of Medicine, H-4032 Debrecen, Hungary.
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Vitalis
authors.affiliation: Maria Papp, Tamas Tornai, Zsuzsanna Vitalis, Istvan Tornai, Department of Internal Medicine, Division of Gastroenterology, University of Debrecen, Faculty of Medicine, H-4032 Debrecen, Hungary.
authors.forename: Istvan
authors.initials: I
authors.lastname: Tornai
authors.affiliation: Maria Papp, Tamas Tornai, Zsuzsanna Vitalis, Istvan Tornai, Department of Internal Medicine, Division of Gastroenterology, University of Debrecen, Faculty of Medicine, H-4032 Debrecen, Hungary.
authors.forename: David
authors.initials: D
authors.lastname: Tornai
authors.affiliation: Maria Papp, Tamas Tornai, Zsuzsanna Vitalis, Istvan Tornai, Department of Internal Medicine, Division of Gastroenterology, University of Debrecen, Faculty of Medicine, H-4032 Debrecen, Hungary.
authors.forename: Tamas
authors.initials: T
authors.lastname: Dinya
authors.affiliation: Maria Papp, Tamas Tornai, Zsuzsanna Vitalis, Istvan Tornai, Department of Internal Medicine, Division of Gastroenterology, University of Debrecen, Faculty of Medicine, H-4032 Debrecen, Hungary.
authors.forename: Andrea
authors.initials: A
authors.lastname: Sumegi
authors.affiliation: Maria Papp, Tamas Tornai, Zsuzsanna Vitalis, Istvan Tornai, Department of Internal Medicine, Division of Gastroenterology, University of Debrecen, Faculty of Medicine, H-4032 Debrecen, Hungary.
authors.forename: Peter
authors.initials: P
authors.lastname: Antal-Szalmas
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001424:Bacterial Infections / Q000097:blood* / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D018950:Lipopolysaccharide Receptors / Q000097:blood*; D008103:Liver Cirrhosis / Q000097:blood* / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D018950:Lipopolysaccharide Receptors; D010446:Peptide Fragments; C000594167:presepsin protein, human; D002116:Calcitonin; D002097:C-Reactive Protein
keywords: Bacterial infection; Cirrhosis; Mortality; Organ failure; Presepsin