title: Presepsin (sCD14-ST) Is a Novel Marker for Risk Stratification in Cardiac Surgery Patients.
abstract: Presepsin (soluble cluster-of-differentiation 14 subtype [sCD14-ST]) is a humoral risk stratification marker for systemic inflammatory response syndrome and sepsis. It remains unknown whether presepsin can be used to stratify risk in elective cardiac surgery. The authors therefore determined the usefulness of presepsin for risk stratification in patients having elective cardiac surgery.
  
  
  
  Eight hundred fifty-six cardiac surgical patients were prospectively studied. Preoperative plasma concentrations of presepsin, procalcitonin, N-terminal pro-hormone natriuretic peptide, cystatin C, and the additive European System of Cardiac Operative Risk Evaluation 2 were compared to mortality at 30 days (primary outcome), 6 months, and 2 yr. Discrimination was assessed with C statistic. Logistic regression analysis was used to calculate univariable and multivariable odds ratios.
  
  
  
  Thirty-day mortality was 3.2%, 6-month mortality was 6.1%, and 2-yr mortality was 10.4% across the population. Median preoperative presepsin concentrations were significantly greater in 30-day nonsurvivors than in survivors: 842 pg/ml (interquartile range, 306 to 1,246) versus 160 pg/ml (interquartile range, 122 to 234); difference, 167 pg/ml (interquartile range, 92 to 301; P < 0.001). The results were similar for 6-month and 2-yr mortality. Compared to the European System of Cardiac Operative Risk Evaluation 2, presepsin concentration provided better discrimination for postoperative mortality at all follow-up periods, including 30 days (C statistic 0.88 vs. 0.74), 6 months (0.87 vs. 0.76), and 2 yr (0.81 vs. 0.74). Presepsin also provided better discrimination than cystatin C, N-terminal pro-hormone natriuretic peptide, or procalcitonin. Elevated presepsin remained an independent risk predictor after adjustment for potential confounding factors.
  
  
  
  Elevated preoperative plasma presepsin concentration is an independent predictor of postoperative mortality in elective cardiac surgery patients and is a stronger predictor than several other commonly used assessments.
authors.affiliation: From the Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine (H.B., T.V., H.V.G.); Division of Nephrology and Hypertension, Department of Medicine (M.K.), Institute for Medical Biometry, Epidemiology, and Medical Informatics (S.W.), and Department of Thoracic and Cardiovascular Surgery (H.-J.S.), Saarland University, University Medical Centre, Homburg/Saar, Germany; DIAneering-Diagnostics Engineering & Research GmbH, Heidelberg, Germany (E.S.); and Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio (D.I.S.).
authors.forename: Hagen
authors.initials: H
authors.lastname: Bomberg
authors.forename: Matthias
authors.initials: M
authors.lastname: Klingele
authors.forename: Stefan
authors.initials: S
authors.lastname: Wagenpfeil
authors.forename: Eberhard
authors.initials: E
authors.lastname: Spanuth
authors.forename: Thomas
authors.initials: T
authors.lastname: Volk
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Schäfers
authors.forename: Heinrich Volker
authors.initials: HV
authors.lastname: Groesdonk
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D018950:Lipopolysaccharide Receptors / Q000097:blood* / Q000235:genetics; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010446:Peptide Fragments / Q000097:blood* / Q000235:genetics; D011183:Postoperative Complications / Q000097:blood* / Q000235:genetics / Q000401:mortality*; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment
chemical_list: D015415:Biomarkers; D018950:Lipopolysaccharide Receptors; D010446:Peptide Fragments; C000594167:presepsin protein, human