Sepsis and bacteremia are conditions that require rapid diagnosis and response. We investigated whether presepsin (PSEP), procalcitonin (PCT), and C-reactive protein (CRP) levels can be used to facilitate the diagnosis of infection and bacteremia.
We retrospectively collected 155 total cases of bacteremia (n = 21), systemic infection without bacteremia (n = 63), and non-infection (n = 71; e.g., post-traumatic high-grade fever) that presented from April 2014 through April 2015 for which PSEP, PCT, and CRP levels were measured during the same episode. When a parameter was measured repeatedly during an episode, only the highest value was analyzed. The final diagnoses were made clinically. The subjects underwent hemodialysis were excluded.
Mean PSEP, PCT, and CRP levels were significantly higher for bacteremic patients than for abacteremic infected and non-infected patients (PSEP: 1886, 1073, and 520 pg/mL, respectively, P < 0.001; PCT: 27.3, 15.5, and 1.47 ng/mL, P < 0.001; CRP: 13.49, 10.78, and 8.37 mg/dL, P = 0.01). According to the area under the receiver–operator curve (AUC), PCT (AUC, 0.81; CI 0.71–0.90, P < 0.001) distinguished bacteremic (n = 21) from non-bacteremic subjects (n = 134) more effectively than did PSEP (AUC, 0.70; CI, 0.59–0.82; P = 0.003) and CRP (AUC, 0.66; CI, 0.54–0.78; P = 0.02). Similarly, PCT (AUC, 0.76; CI, 0.69-0.83; P < 0.001) also discriminated between infected (n = 84) and non-infected patients more accurately than did PSEP (AUC, 0.71; CI, 0.63-0.79, P < 0.001) and CRP (AUC, 0.63; 0.54-0.72, P = 0.006). PCT levels of 5.64 ng/mL (sensitivity, 66.7%; specificity, 85.1%) and 1.22 ng/mL (60.7%; 83.1%) and PSEP concentrations of 926.5 pg/mL (57.1%; 79.1%) and 698.5 pg/mL (47.6%; 83.1%) were established as appropriate cut-off values for the diagnosis of bacteremia and systemic infection, respectively.
CRP was only marginally diagnostic of bacteremia. In contrast, PSEP and PCT levels were useful for diagnosing bacteremia (≥ 920 pg/mL and ≥ 5.5 ng/mL, respectively) and systemic infection (≥ 720 pg/mL and ≥ 1.2 ng/mL). According to the AUC, PCT was more predictive of infection and bacteremia than was PSEP.
T. Kaneko, None