Presepsin and procalcitonin kinetics for sepsis early risk stratification: A multicenter clinical chemistry study

Background: Early risk stratification in sepsis is difficult in outpatient pathways, in which deterioration may occur after the first visit. Single baseline biomarker values usually demonstrate limited value in prognostic discrimination. This study assessed the use of early presepsin and procalcitonin kinetics in improving the prediction of 28-day mortality in suspected sepsis.

Methods: A prospective, observational, and multicenter cohort study for the data collection in outpatient clinics of Babylon Governorate in Iraq, was devised. Consecutive patients aged 6-65 years with suspicion of infection and systemic features of illness were entered (will enter 150 patients). Blood samples were taken at T0, T24 (24 ± 6 h) and T48 (48 ± 6 h), and blood samples were sent to a central laboratory for measurement of presepsin and procalcitonin. The kinetics were reported as absolute values and clearance % (T0-Tt)/T0*100 (T0-Tt)/T0*100 (T0-Tt)/T0*100. The primary endpoint was death (all-causes), all the way up to day 28, measured as a clinic revisit within day 28. Prognostic performance was analyzed with the help of logistic regression and receiver operating characteristic analysis.

Results: Participants =150, mortality rate at 28 days was 14.0% (21/150). Follow-up biomarker availability to 24 hrs and 48 h was 91% and 80%, respectively. Baseline presepsin and procalcitonin showed low discrimination in terms of mortality (AUC 0.566 and 0.535, respectively). In contrast, 48h clearance showed excellent prognostic performances (presepsin clearance 48 AUC 0.812; procalcitonin clearance 48 AUC 0.824). In an adjusted kinetic model (n= 120 and T48), a lower clearance was also independently correlated with mortality (10% decrease was associated with presepsin clearance 48 of 1.50 and procalcitonin clearance 48 of 1.73), and the model achieved high discrimination (AUC 0.911).

Conclusions: Early presepsin and procalcitonin kinetics, and specifically, 48-hour clearance, may clinically increase outpatient-oriented risk stratification performance for 28-day mortality to a very high degree than baseline values alone.