Newly Published
Perioperative Medicine  |   January 2017
Presepsin (sCD14-ST) Is a Novel Marker for Risk Stratification in Cardiac Surgery Patients
Author Notes
  • From the Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine (H.B., T.V., H.V.G.); Division of Nephrology and Hypertension, Department of Medicine (M.K.), Institute for Medical Biometry, Epidemiology, and Medical Informatics (S.W.), and Department of Thoracic and Cardiovascular Surgery (H.-J.S.), Saarland University, University Medical Centre, Homburg/Saar, Germany; DIAneering—Diagnostics Engineering & Research GmbH, Heidelberg, Germany (E.S.); and Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio (D.I.S.).
  • This article is featured in “This Month in Anesthesiology,” page 1a.
    This article is featured in “This Month in Anesthesiology,” page 1a.×
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    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication June 5, 2016. Accepted for publication December 16, 2016.
    Submitted for publication June 5, 2016. Accepted for publication December 16, 2016.×
  • Research Support: Supported by the DIAneering—Diagnostics Engineering and Research consulted to Axis-Shield Diagnostics Ltd. (Dundee, Scotland), LSI Medience Corporation (Tokyo, Japan), Mitsubishi Chemical Europe (Düsseldorf, Germany), Radiometer GmbH (Willich, Germany), Roche Diagnostics Deutschland GmbH (Mannheim, Germany), Saladax Biomedical Inc. (Bethlehem, Pennsylvania), and Shanghai Kehua Bio-engineering Co. Ltd. (Shanghai, China).
    Research Support: Supported by the DIAneering—Diagnostics Engineering and Research consulted to Axis-Shield Diagnostics Ltd. (Dundee, Scotland), LSI Medience Corporation (Tokyo, Japan), Mitsubishi Chemical Europe (Düsseldorf, Germany), Radiometer GmbH (Willich, Germany), Roche Diagnostics Deutschland GmbH (Mannheim, Germany), Saladax Biomedical Inc. (Bethlehem, Pennsylvania), and Shanghai Kehua Bio-engineering Co. Ltd. (Shanghai, China).×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Groesdonk: Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Kirrbergerstraße 1, 66421 Homburg/Saar, Germany. heinrich.groesdonk@uniklinikum-saarland.de. This article may be accessed for personal use at no charge through the Journal Web site, www.anesthesiology.org.
Article Information
Perioperative Medicine / Cardiovascular Anesthesia
Perioperative Medicine   |   January 2017
Presepsin (sCD14-ST) Is a Novel Marker for Risk Stratification in Cardiac Surgery Patients
Anesthesiology Newly Published on January 19, 2017. doi:10.1097/ALN.0000000000001522
Anesthesiology Newly Published on January 19, 2017. doi:10.1097/ALN.0000000000001522
Abstract

Background: Presepsin (soluble cluster-of-differentiation 14 subtype [sCD14-ST]) is a humoral risk stratification marker for systemic inflammatory response syndrome and sepsis. It remains unknown whether presepsin can be used to stratify risk in elective cardiac surgery. The authors therefore determined the usefulness of presepsin for risk stratification in patients having elective cardiac surgery.

Methods: Eight hundred fifty-six cardiac surgical patients were prospectively studied. Preoperative plasma concentrations of presepsin, procalcitonin, N-terminal pro–hormone natriuretic peptide, cystatin C, and the additive European System of Cardiac Operative Risk Evaluation 2 were compared to mortality at 30 days (primary outcome), 6 months, and 2 yr. Discrimination was assessed with C statistic. Logistic regression analysis was used to calculate univariable and multivariable odds ratios.

Results: Thirty-day mortality was 3.2%, 6-month mortality was 6.1%, and 2-yr mortality was 10.4% across the population. Median preoperative presepsin concentrations were significantly greater in 30-day nonsurvivors than in survivors: 842 pg/ml (interquartile range, 306 to 1,246) versus 160 pg/ml (interquartile range, 122 to 234); difference, 167 pg/ml (interquartile range, 92 to 301; P < 0.001). The results were similar for 6-month and 2-yr mortality. Compared to the European System of Cardiac Operative Risk Evaluation 2, presepsin concentration provided better discrimination for postoperative mortality at all follow-up periods, including 30 days (C statistic 0.88 vs. 0.74), 6 months (0.87 vs. 0.76), and 2 yr (0.81 vs. 0.74). Presepsin also provided better discrimination than cystatin C, N-terminal pro–hormone natriuretic peptide, or procalcitonin. Elevated presepsin remained an independent risk predictor after adjustment for potential confounding factors.

Conclusions: Elevated preoperative plasma presepsin concentration is an independent predictor of postoperative mortality in elective cardiac surgery patients and is a stronger predictor than several other commonly used assessments.