The role of serum presepsin in paediatric sepsis

Objectives: To evaluate the performance of serum presepsin in paediatric sepsis and compare it with serum procalcitonin and C-reactive protein (CRP).
Method:  It is a prospective observational study that included children aged one month to 17 years admitted to the paediatric intensive care unit with suspicion of sepsis based on International Paediatric Sepsis Consensus Criteria for sepsis (2005). A one-time blood sample was drawn for assessing serum presepsin, procalcitonin and CRP at admission. The subjects were divided into sepsis and severe sepsis group and the biomarkers were compared for predicting severity and outcome.
Results: Of 84 patients, 47 (56%) had sepsis and 37 (44%) had severe sepsis. The mean serum presepsin, procalcitonin and CRP in the sepsis group was 549pg/ml, 2.17ng/ml and 5.15mg/dl respectively while the mean values in severe sepsis were 3440.5pg/ml, 3.64 ng/ml and 10.41 mg/dl respectively and all were statistically significant (p value <0.01). Area under the curve (AUC) of serum presepsin (0.814) was highest followed by CRP (0.749) and procalcitonin (0.718) in predicting severity. With >650 pg/ml, serum presepsin had 70.3% sensitivity, 87% specificity, 80% positive predictive value (PPV) and 76% negative predictive value (NPV). Serum procalcitonin >2ng/ml, had 70% sensitivity, 68% specificity, 74% PPV and 63% NPV. CRP >5.75mg/dl had 62% sensitivity, 70% specificity, 63% PPV and 74% NPV. Similarly, serum presepsin showed higher specificity (95 % vs 55% and 49%) and PPV (55 % vs 17% and 15%) than procalcitonin and CRP in predicting mortality.
Conclusions: Serum presepsin was better than procalcitonin and CRP in predicting both severity and mortality in septic children. Serum presepsin had the highest specificity and predictive values among the tested biomarkers.