The Significance Of Presepsin In Chronic Kidney Disease With Sepsis

Objective:To evaluate the diagnostic value of serum presepsin(soluble CD14-ST)levels for sepsis in patients with chronic kidney disease and the influence of undergoing hemodialysis on serum presepsin.Methods:This prospective study included 291 patients with chronic kidney disease admitted to the nephrology department of the First Affiliated Hospital of Dalian Medical University between May 2017 and November 2017.Patients were grouped by the presence or absence of sepsis,diagnosed according to the Third International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3).(chronic kidney disease with sepsis n=124)and group B(chronic kidney disease without sepsis n=167);Each group was further stratified based on whether patients underwent hemodialysis or not.A1 group(line hemodialysis n=57),A2 group(not hemodialysis n= 67)and B1 group(line hemodialysis n=87),group B2(not hemodialysis n=80),subgroup;48 healthy volunteers were included as controls.Blood samples were collected on Day 1,Day 3,and Day 7 of admission for presepsin,procalcitonin(PCT),and C-reactive protein(CRP)determination.Receiver operating characteristic(ROC)curves were constructed to assess the significance of presepsin,PCT and CRP for predicting sepsis in patients with chronic kidney disease undergoing hemodialysis or not..Results:(1)The levels of Presepsin in group chronic kidney disease with with sepsis and group chronic kidney disease without sepsis were higher than those in group controls(P<0.01),and group chronic kidney disease with with sepsis was higher than group chronic kidney disease with without sepsis(P<0.01).(2)Presepsin in group chronic kidney disease with without sepsis no not undergoing hemodialysis was higher than group controls(P<0.01).(3)Presepsin was higher in group chronic kidney disease with sepsis not undergoing hemodialysis than in group chronic kidney disease without sepsis no hemodialysis.(P<0.05);(4)Presepsin in group chronic kidney disease withoutsepsis undergoing hemodialysis was higher than group chronic kidney disease without sepsis no hemodialysis(P<0.05).(5)Presepsin in group chronic kidney disease with sepsis undergoing hemodialysis.was higher than group chronic kidney disease with sepsis no hemodialysis(P<0.05).(6)In patients with chronic kidney disease and not undergoing hemodialysis.,the area under curve(AUC)for presepsin was 0.961(95%confidence interval [CI]: 0.940-0.982),the AUC for PCT was 0.877(95% CI:0.835-0.918),and the AUC for CRP was 0.749(95% CI: 0.686-0.812).Presepsin predicted sepsis at a cut off value of 342 pg/mL,with a sensitivity and specificity of90.2% and 83.9%,respectively.PCT predicted sepsis at a cut off value of 0.625 ng/L,with a sensitivity and specificity of 83.9% and 75.8%,respectively.CRP predicted sepsis at a cut off value of 9.125 mg/L,with a sensitivity and specificity of 75.6% and75.8%,respectively.(7)In patients with chronic kidney disease undergoing hemodialysis,the AUC for presepsin was 0.650(95% CI: 0.594-0.707),the AUC for PCT was 0.876(95% CI: 0.842-0.911),and the AUC for CRP was 0.802(95% CI: 0.755-0.849).Presepsin predicted sepsis at a cut off value of 3076 pg/mL,with a sensitivity and specificity of 30.5% and 99.2%,respectively.PCT predicted sepsis at a cut off value of3.182 ng/L,with a sensitivity and specificity of 84.8% and 82.7%,respectively.CRP predicted sepsis at a cut off value of 45.7 mg/L,with a sensitivity and specificity of78% and 82.4%,respectively.Conclusion:1.serum Presepsin levels are increased in patients with Chronic kidney disease,Sepsis;Hemodialysis;Presepsin be more significant when Chronic kidney disease combined with sepsis or combined with Hemodialysis;serum Presepsin are highest in patients with CKD and sepsis undergoing hemodialysis.2.Presepsin has better diagnostic value for sepsis than PCT or CRP in patients with chronic kidney disease not undergoing hemodialysis.3.Presepsin has limited diagnostic value for sepsis in patients with chronic kidney disease undergoing hemodialysis,but may be useful to identify patients with chronickidney disease that is not complicated by sepsis,and when combined with PCT and CRP,as a biomarker for early intervention.