Presepsin, resistin may aid in bacterial infection diagnosis in patients with cirrhosis

Presepsin and resistin appear to be helpful early markers of bacterial infection in patients with decompensate cirrhosis, a recent study has shown.

Researchers enrolled 114 consecutive patients (mean age, 60±10 years; 74.5 percent male) with decompensated liver cirrhosis from whom venous blood samples were drawn. Concentrations of the biomarkers were determined using the appropriate test kits. Bacterial infections were determined through culture positivity and cell counts.

Almost half of the patients were positive for bacterial infections upon admission; 14 were infected at multiple sites and 30 satisfied the criteria for sepsis. Spontaneous bacterial peritonitis was the most frequent infection. Presepsin and resistin, along with C-reactive protein (CRP) and procalcitonin, were all enriched in those who had infections and sepsis.

Presepsin was significantly diagnostic of infections (area under the receiver operating characteristic curve [AUROC], 0.75, 95 percent confidence interval [CI], 0.67–0.84; p<0.001). Its performance was not significantly different than for CRP (p=0.87), procalcitonin (p=0.54) and resistin (p=0.76).

At an identified optimal cutoff value of 1,444 pg/mL, prespsin was able to accurately identify infection in 70 percent of patients and sepsis in 80 percent. However, when using the prespecified cutoff of 600 pg/mL, used in noncirrhotic patients, accuracy dropped to 60 percent (p=0.2) and 53 percent (p<0.0001), respectively.

Resistin performed comparably. At the cutoff of 20 ng/mL, 71 percent and 70 percent of patients could correctly be identified as having an infection or sepsis, respectively. Raising the threshold to 36.5 ng/mL worsened accuracy to 67 percent for infections but improved to 73 percent for sepsis.