title: Diagnostic and Prognostic Value of Presepsin for Subclinical Chorioamnionitis in Pregnancies between 23-28 Week with Preterm Premature Rupture of the Membranes.
abstract: BACKGROUND
  Presepsin is an inflammatory marker released from monocytes and macrophages as an acute reaction to microbial infection. We hypothesized that it may be useful in pregnancies with preterm premature rupture of the membranes (PPROM) for early diagnosis of subclinical chorioamnionitis.
  
  
  OBJECTIVE
  To determine whether the plasma presepsin level has any diagnostic or prognostic value for subclinical chorioamnionitis in pregnancies complicated with PPROM.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Fifty-three singleton pregnancies between 23 and 28 weeks of gestation diagnosed with PPROM were prospectively included in the study. Venous blood samples were collected at admission, at the 48thhour of admission, and at the time of delivery to determine presepsin and C-reactive Protein (CRP) levels and white blood cell (WBC) counts. Chorioamnionitis was diagnosed by microscopic examination of the placenta and cords.
  
  
  RESULTS
  Of the 53 PPROM cases included in the study, 41 (77.4%) had histologically confirmed chorioamnionitis. Neonatal sepsis developed in 24 (45.3%) of the newborns. The median presepsin level at admission was 135.0 pg/mL for pregnancies with subclinical chorioamnionitis and 113.5pg/mL for pregnancies without chorioamnionitis (p=0.573). There was also no significant difference between subclinical chorioamnionitis (+) and (-) cases in terms presepsin levels at the 48thhour and at delivery. However, chorioamnionitis (+) cases showed a significant decrease in both presepsin level and WBC count at the 48thhour after the administration of antibiotics, which increased significantly at delivery (p<0.001 and p=0.011, respectively).
  
  
  CONCLUSIONS
  The striking fluctuations in presepsin level after the diagnosis of PPROM can be used to predict subclinical chorioamnionitis and determine the optimal timing of delivery before the clinical signs of chorioamnionitis are established. However, presepsin level itself was neither diagnostic nor prognostic for neonatal sepsis.
authors.affiliation: Department of Obstetrics and Gynecology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, İstanbul, Turkey.
authors.forename: Erbil
authors.initials: E
authors.lastname: Çakar
authors.affiliation: Deparment of Infectious Diseases, Ümraniye Training and Research Hospital, İstanbul, Turkey.
authors.forename: Şule Eren
authors.initials: ŞE
authors.lastname: Çakar
authors.affiliation: Department of Obstetrics and Gynecology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, İstanbul, Turkey.
authors.forename: Habibe Ayvacı
authors.initials: HA
authors.lastname: Taşan
authors.affiliation: Department of Obstetrics and Gynecology, Gazi University School of Medicine, Ankara, Turkey.
authors.forename: Deniz
authors.initials: D
authors.lastname: Karçaaltıncaba
authors.affiliation: Department of Obstetrics and Gynecology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, İstanbul, Turkey.
authors.forename: Mehmet Baki
authors.initials: MB
authors.lastname: Şentürk
authors.affiliation: Department of Pathology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, İstanbul, Turkey.
authors.forename: Nermin
authors.initials: N
authors.lastname: Koç
authors.affiliation: Department of Clinical Microbiology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, İstanbul, Turkey.
authors.forename: Ramazan
authors.initials: R
authors.lastname: Uluhan
keywords: Premature rupture of the membranes; chorioamnionitis; neonatal sepsis; preterm