Presepsin (sCD14-ST) in emergency department: the need for adapted threshold values?

Presepsin is elevated in patients developing infections and increases in a severity-dependent manner. We aimed to evaluate circulating values of this new biomarker in a population free of any acute infectious disorder. We recruited 144 consecutive patients presenting at the emergency department (ED) without acute infection or acute/unstable disorder, and 54 healthy participants. Presepsin plasmatic concentrations were measured on the PATHFAST point-of-care analyzer. The 95th percentile of presepsin values in the ED population is 750ng/L. Presepsin was significantly increased in patients aged ≥70years vs. younger patients (470 [380-601] ng/L vs. 300 [201-457] ng/L, p<0.001). Prevalence of elevated presepsin values was increased in patients in comparison to controls (80% vs.13%, p<0.001), and in patients aged ≥70years in comparison to younger patients (87% vs. 47%, p<0.001). Presepsin concentrations were significantly increased in patients with kidney dysfunction. Aging was an independent predictor of an elevated presepsin value. In conclusion, presepsin concentrations increase with age and kidney dysfunction. Therefore interpretation of presepsin concentrations might be altered in the elderly or in patients with impaired renal function. Adapted thresholds are needed for specific populations.