Plasma concentration of presepsin and its relationship to the diagnosis of infections in multiple trauma patients admitted to intensive care

Background and aims: Septic complications represent the predominant cause of late death in poly-trauma patients. The necessity to differentiate septic from non septic patients is more relevant at the early stage of the illness in order to improve the clinical outcome and to reduce the mortality. The identification of a sensitive and specific, clinically reliable, biomarker capable to early recognize incoming septic complications in trauma patients whose expression is not influenced by concomitant traumatic injuries, is still a challenge for the researchers in the field.
Materials and methods: A retrospective analysis on 48 adult patients (9 females and 39 males, mean age 47.6±19 years) with multiple trauma was performed. The inclusion criterion was to suffer from acute trauma since no more than 24 hours and the exclusion criteria were the following: antibiotic treatment on admission and maintained for more than 48 hours; on-going infection on admission not associated with trauma; treatment with immunosuppressors/ immunomodulants; age <18 years old. Presepsin was measured using an automated chemiluminescence analyser at 1, 3, 5 and 8 days post of hospitalization. The diagnosis of systemic inflammatory response syndrome (SIRS)/infection was established according to the criteria of the Surviving Sepsis Campaign.
Results and conclusions: In patients with SIRS, the mean presepsin concentration was 917,08 (±69.042) ng/L vs 980,258 (±1951.32) ng/L in patients without SIRS (P=0.769). In the infected patients, the mean presepsin concentration was 1513.25 (±2296.54) ng/L vs 654.21 (±511,068) ng/L (P<0.05) calculated among the non infected upon admission. The plasma presepsin concentration increased progressively during the first 8 days of hospitalization. Presepsin concentration in the infected patients was significantly higher than in non-infected patients. On the other hands no significant differences were found in the plasma level of presepsin among patients with and without SIRS. Any other clinical condition related to the trauma did not affect presepsin. Our data clearly suggest that presepsin may be considered an helpful diagnostic tool to early diagnose sepsis in trauma patients.