article · International Journal of Infectious Diseases
Hospitalised patients with moderate to severe COVID-19 pneumonia require accurate prognostic markers to guide clinical care. A multicentre observational study examined the relationship between presepsin, a soluble biomarker previously proposed for sepsis, and patient outcomes alongside standard inflammatory markers. Evaluating 202 confirmed patients across facilities in Saudi Arabia and Egypt, the investigation compared clinical trajectories against measured presepsin levels. Patients who did not survive exhibited significantly higher presepsin values than survivors, and intensive care admissions showed similarly elevated concentrations compared to non-intensive care cohorts. Furthermore, increased presepsin concentrations correlated with longer hospital stays. At a defined threshold of 775 pg/mL, presepsin demonstrated notable specificity and sensitivity in identifying patients at risk of in-hospital death. These findings demonstrate that elevated presepsin reflects poor clinical outcomes and mortality risk in hospitalised COVID-19 pneumonia cases.
Accurately predicting which hospitalised COVID-19 patients face the highest risk of death is vital for triaging care and allocating intensive medical resources. Measuring presepsin levels provides clinical teams with a biological indicator to recognise life-threatening deterioration early, assisting decisions around intensive care unit admission and targeted interventions.
This work could inform diagnostic developers and clinical laboratories seeking to validate presepsin assays for respiratory triage. Hospital emergency departments and intensive care units are the primary end users. Because the evidence stems from a retrospective observational study of 202 patients, the diagnostic application is at an applied research stage and requires prospective clinical validation before commercial deployment.
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OBJECTIVES: Different biomarkers such as C-reactive protein (CRP), serum ferritin and D-dimer are used in prognostic assessment of patients with COVID-19 pneumonia. Presepsin (PSP) is a soluble CD14 subtype that has recently been proposed as a novel biomarker in patients with sepsis. The aim of the current study was to detect the relation of PSP to the outcome of COVID-19 as well as its relation to other inflammatory biomarkers. METHODS: This multicenter retrospective observational study was conducted in Saudi Arabia and Misr International Hospital, Egypt, from January 2021 to May 2021. Hospitalised patients who had positive throat swab of SARS-CoV-2 and radiological evidence of viral pneumonia (moderate and severe forms) were included in the study. Demographics and clinical features, as well as laboratory parameters, including serum ferritin, CRP, D-dimer and PSP, of enrolled patients were retrospectively collected. Pneumonia severity index (PSI) was used to evaluate the severity of pneumonia. RESULTS: A total of 202 hospitalised patients who were diagnosed with COVID-19 pneumonia and tested positive for SARS-CoV-2 RNA were enrolled in our study. Of 202 hospitalised patients, 67 (33.17%) required intensive care unit (ICU) admission. A total of 176 (87.1%) patients survived and were discharged, whereas 26 (12.9%) patients did not survive. PSP level was found to be significantly elevated in nonsurvivor versus survivor group (median [IQR] 978.5 [755.8-1400] vs 516.5 [343.3-720], P<0.001) as well as in ICU versus non-ICU patients (median [IQR] 800 [631-1200] and 446 [320-626], respectively) (P<0.001). Elevated levels were also found to be associated with increased length of hospital stay. Levels above 775 pg/mL were found to be associated with in-hospital mortality (specificity 80%, sensitivity 73%). CONCLUSION: Elevated PSP levels indicated poor outcomes in hospitalised patients with COVID-19 pneumonia and were associated with in-hospital mortality.
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DOI: 10.1016/j.ijid.2022.02.054
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