Presepsin is a potent biomarker for diagnosing skin wound infection in hemodialysis patients compared to white blood cell count, high-sensitivity C-reactive protein, procalcitonin, and soluble CD14

Abstract

Background: The production of presepsin has been shown to be strongly related to bacterial phagocytosis. The purpose of the present study is to compare the usefulness of presepsin for diagnosing localized skin wound infection with that of conventional infection biomarkers. Methods: We enrolled 29 hemodialysis (HD) patients with skin wound infections of foot gangrene or decubitus ("localized infection group") and 20 HD patients without infection ("no infection group"). The white blood cell (WBC) count and high-sensitivity C-reactive protein (hsCRP) and presepsin levels were measured using blood samples collected before HD, 2 days after the previous dialysis session. Soluble CD14 (sCD14) and procalcitonin (PCT) levels were also measured in 12 patients with localized infection and 8 patients without infection. Results: The levels of hsCRP and presepsin were significantly higher in the localized infection group (N = 29) than in the no infection group (N = 20) (P = 0.0209 and 0.0000, respectively). In receiver operating characteristics (ROC) analyses, when the cut-off values of hsCRP and presepsin were set at 1.07 mg/dL and 2080 pg/mL, respectively, the sensitivity was 0.69 and 0.86, and the specificity was 0.70 and 0.80, respectively. The area under the curve (AUC) was calculated as 0.696 for hsCRP and 0.874 for presepsin. The AUC for presepsin was significantly higher than that for hsCRP (P = 0.0348). No marked differences were found in the age, gender, WBC, or sCD14 or PCT levels between groups. Conclusions: Presepsin is a potent, useful biomarker for diagnosing skin wound infection in HD patients compared to conventional infection biomarkers.