Diagnostic accuracy of presepsin in predicting bacteremia in elderly patients admitted to the emergency department: prospective study in Japan

Objective

Early detection of bacteremia in the elderly is needed in the emergency department (ED).

Design, Setting, and Participants

Prospective study in Japan, single center trial in patients who satisfied the sepsis criteria was conducted between September 2014 and March 2016. Forty-six elderly patients aged ≥70 years were included.

Interventions

Blood sampling to evaluate C-reactive protein (CRP), procalcitonin (PCT) and presepsin plasma levels; two sets of blood sampling for bacterial cultures; and evaluations of the Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE II) scores were performed upon arrival at the ED. The results were compared between patients with bacteremia and those without bacteremia.

Main Outcome Measure

The accuracy of detecting bacteremia

Results

The presepsin value was significantly higher in the bacteremia group than in the non-bacteremia group (866.6 ± 184.6 pg/mL vs. 639.9 ± 137.1 pg/mL, p = 0.03). The PCT and CRP did not significantly differ between the groups. The area under the receiver-operating-characteristic curve (AUC) values were not significantly different among presepsin (0.69), PCT (0.61), and CRP (0.53). Multivariate analysis showed that presepsin was independently associated with bacteremia (odds ratio, 8.84; 95% confidence interval, 0.95–81.79; p = 0.02).

Conclusion

Presepsin could be a good biomarker to predict bacteremia in elderly patients with sepsis criteria admitted to the ED.