Levels of presepsin and midregion-proadrenomedullin in septic patients with end-stage renal disease after cardiovascular surgery: 1-year follow up study

Abstract

Background: Procalcitonin (PCT) is a marker for sepsis diagnosis, identification of bacterial infection and monitoring of antibiotic therapy. It has been shown that PCT is not a good choice in patients with hemodialysis. Therefore, we have explored two biomarkers: a) presepsin, and, b) midregion-proadrenomedullin (MR-proADM) in patients having End-Stage Renal Disease (ESRD). Patients and Methods: We prospectively enlisted 20 patients, who underwent cardiovascular surgery and had been on dialysis. The diagnosis of sepsis has been established clinically and confirmed by PCT. Blood samples were taken before and after dialysis. Additionally, plasma and sera of 10 healthy blood donors without any complications were used as controls. Results: Presepsin plasma concentrations (4368 ± 3088 vs. 694.1 ± 239.1 pg/mL) were significantly higher in patients with sepsis compared with controls (p<0.0001), but without significance between survivors and nonsurvivors (p=0.77). Circulating levels of MR-proADM (4.15 ± 2.72 vs. 0.294 ± 0.03 nmol/L) were also elevated in ESRD patients (p>0.05) with no significance between alive and deceased (p=0.53) patients. Adjustments have shown that the difference for MR-proADM level is due to the random sampling variability (p=0.989), whereas difference for presepsin remained highly significant (p<0.001). Conclusions: Our results indicate that the accuracy of new biomarkers is equal to that of PCT in patients with ESRD. Presepsin might be as good marker in repeated measurements, before and after dialysis, as it is PCT. © 2014 Maravic-Stojkovic V, et al.