Yann-Erick Claessens1, Eloise Trabattoni2, Sophie Grabar3, Laurent Quinquis3, Guillaume Der Sahakian4, Marine Anselmo5, Jeannot Schmidt6, Jean-Emmanuel de la Coussaye7, Patrick Plaisance8, Enrique Casalino9, Gilles Potel10, François Lecomte4, Didier Borderie11, Camille Chenevier-Gobeaux12. 1. Centre Hospitalier Princesse Grace, Department of Emergency Medicine, 1 avenue Pasteur BP489 MC-98012, Monaco; Hôpital Cochin, Hôpitaux Universitaires Paris Centre (HUPC), Assistance Publique des Hôpitaux de Paris (AP-HP). Department of Emergency Medicine, 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, France. 2. Hôpital Cochin, Hôpitaux Universitaires Paris Centre (HUPC), Assistance Publique des Hôpitaux de Paris (AP-HP). Department of Emergency Medicine, 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, France; Faculté de Médecine, Université Paris Descartes, 10 rue de l'école de médecine, 75006 Paris, France. 3. Hôpital Hôtel-Dieu, Hôpitaux Universitaires Paris Centre (HUPC), Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Biostatistics and Epidemiology, 1, place du Parvis de Notre-Dame, 75181 Paris Cedex 04, France; Faculté de Médecine, Université Paris Descartes, 10 rue de l'école de médecine, 75006 Paris, France. 4. Hôpital Cochin, Hôpitaux Universitaires Paris Centre (HUPC), Assistance Publique des Hôpitaux de Paris (AP-HP). Department of Emergency Medicine, 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, France. 5. Hôpital Cochin, Hôpitaux Universitaires Paris Centre (HUPC), Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Automated Biological Diagnosis, 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, France. 6. Hôpital d'Estaing, Department of Emergency Medicine, 58 rue Montalembert, 63003 Clermont-Ferrand Cedex 1, France. 7. Hôpital Caremeau, Department of Anaesthesiology, Emergency Medicine and Pain Management, Place Robert Debré, 31000 Nîmes, France. 8. Hôpital Lariboisière, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal, Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Emergency Medicine, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France. 9. Hôpital Bichat-Claude Bernard, Hôpitaux Universitaires Paris-Nord Val-de-Seine (HUPNVS), Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Emergency Medicine, Rue Henri Huchard, 75651 Paris Cedex 13, France; Faculté de Médecine, Université René Diderot, 10 rue de Valmy, 75011 Paris, France. 10. Hôtel-Dieu, Department of Emergency Medicine, 1 place Alexis-Ricordeau, 44093, Nantes, France. 11. Hôpital Cochin, Hôpitaux Universitaires Paris Centre (HUPC), Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Automated Biological Diagnosis, 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, France; Paris Descartes University, Sorbonne Paris Cité University, University Paris Descartes UMR-S 1124 INSERM, Paris, France. 12. Hôpital Cochin, Hôpitaux Universitaires Paris Centre (HUPC), Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Automated Biological Diagnosis, 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, France. Electronic address: camille.gobeaux@aphp.fr.
Abstract
INTRODUCTION: Presepsin (sCD14-ST) is an emerging biomarker for infection. We hypothesized that presepsin could specifically increase during acute pyelonephritis and correlate with severity. METHODS: We compared presepsin values in patients with acute pyelonephritis and controls, and we assessed its capacity to predict bacteraemia and admission in patients. RESULTS: In 312 patients with acute pyelonephritis (median age 33years), presepsin concentrations were higher than in controls (476 vs 200ng/L, p<0.001). ROC curve indicated an AUC at 0.90 [for presepsin (vs. 0.99 and 0.98 for CRP and PCT, respectively; p<0.05) and an optimal threshold at 340ng/L (74% sensitivity, 94% specificity). Presepsin concentrations increased in acute pyelonephritis patients with bacteraemia (614 vs. 461ng/L, p,=0.001) and in those requiring admission (614ng/L vs. 320ng/L, p<0.001). Performance of presepsin to predict bacteraemia [AUC=0.63, 95%CI: 0.55-0.72] was similar to CRP (AUC=0.64, p=0.87) and less accurate than PCT (AUC=0.78, p<0.001). AUC for presepsin to detect the need for admission was 0.67, and comparable to CRP (p=0.26) and PCT (p=0.18). CONCLUSION: Presepsin is a valuable biomarker to detect patients with acute pyelonephritis. However, it presents mild performance to predict bacteraemia and the need for admission, and offers no advantage as compared to CRP and PCT.
INTRODUCTION: Presepsin (sCD14-ST) is an emerging biomarker for infection. We hypothesized that presepsin could specifically increase during acute pyelonephritis and correlate with severity. METHODS: We compared presepsin values in patients with acute pyelonephritis and controls, and we assessed its capacity to predict bacteraemia and admission in patients. RESULTS: In 312 patients with acute pyelonephritis (median age 33years), presepsin concentrations were higher than in controls (476 vs 200ng/L, p<0.001). ROC curve indicated an AUC at 0.90 [for presepsin (vs. 0.99 and 0.98 for CRP and PCT, respectively; p<0.05) and an optimal threshold at 340ng/L (74% sensitivity, 94% specificity). Presepsin concentrations increased in acute pyelonephritispatients with bacteraemia (614 vs. 461ng/L, p,=0.001) and in those requiring admission (614ng/L vs. 320ng/L, p<0.001). Performance of presepsin to predict bacteraemia [AUC=0.63, 95%CI: 0.55-0.72] was similar to CRP (AUC=0.64, p=0.87) and less accurate than PCT (AUC=0.78, p<0.001). AUC for presepsin to detect the need for admission was 0.67, and comparable to CRP (p=0.26) and PCT (p=0.18). CONCLUSION: Presepsin is a valuable biomarker to detect patients with acute pyelonephritis. However, it presents mild performance to predict bacteraemia and the need for admission, and offers no advantage as compared to CRP and PCT.