presepsin in the diagnosis of early onset sepsis (EOS)

Last edited 06/2022 and last reviewed 06/2022

Presepsin in the diagnosis of early onset sepsis (EOS)

  • early-onset sepsis (EOS) is defined as a blood or cerebrospinal fluid culture obtained during the first 72 hours of life that grows a pathogenic bacterial species (1)
    • incidence is reported to range from 0.5 to 1 in 1000 live births in full-term (term) newborns (>=37 weeks of gestational age) to 3% to 4% at 22 to 24 weeks of gestational age (GA)
    • case-fatality rate is 0% to 3% in term infants,30% at 25 to 28 weeks of age, and 54% at 22 to 24 weeks of age

  • presepsin results from the cleavage of CD14 by circulating bacterial proteases during sepsis (1,2)
    • CD14 is the receptor of lipopolysaccharide-lipopoly-saccharide binding protein (LPS-LBP) complexes
      • with the assistance of thinositol lipid structure, the carboxyl terminus of the molecule anchors in cell membrane and transducts the endotoxin signal through the Toll-like receptor-4
      • there is the gradual downstream activation of a series tyrosine protein kinases and mitogen-activated protein kinase
        • leading to the release of cytokines such as tumor necrosis factor-alpha, IFN-gamma, IL-1beta, IL-8 and IL-6
        • subsequently, the activation of the secondary inflammatory cascade and acquired immunity stimulate mononuclear macrophages, neutrophils and endothelial cells to release more cytokines and cell adhesion molecules
          • may trigger intense and excessive systemic inflammatory response and activate the coagulation and fibrinolytic systems, resulting in SIRS, sepsis shock, disseminated intravascular coagulation (DIC), and multiple organ dysfunction syndrome (MODS)

A systematic review and meta-analysis suggests that presepsin is an accurate biomarker of EOS (1)