Assistant professor Keio University School of Medicine
Background: Presepsin is known as promising diagnostic biomarker for infection including sepsis. However, no study has determined presepsin's role post-esophagectomy which is one of invasive surgery in the gastrointestinal fields, thus we aimed to investigate presepsin diagnostic accuracy for infectious complications after esophagectomy compared with conventional biomarkers (leukocyte, C-reacted protein and procalcitonin).
Methods: Thirty patients who underwent esophagectomy for esophageal cancer were included in this prospective observational study. We investigated preoperative presepsin levels changes and evaluated the relationship between infectious complications and presepsin levels. The results' accuracy for complication prediction, was evaluated by the area under the curve (AUC), determined from the analysis of the receiver operator characteristics curve.
Results: For 10 patients with infectious complications, median presepsin levels were 168, 337, 303, 271, 314, 978, and 752 pg/ml, pre- and immediately post-esophagectomy, and 1, 2, 3, 5, 7 days post- esophagectomy, respectively. The median day of diagnosis of complication was 6 days postsurgery. Presepsin levels were significantly higher in the infectious complication group exclusively from pre-esophagectomy to POD 7 (p = 0.048). Furthermore, AUC value of presepsin on POD 5 and 7 was higher than the other three biomarkers included for discriminating infectious complications. We set an optimal cutoff value for presepsin, and the cutoff was 888 pg/ml with a sensitivity of 60% and a specificity of 90% on POD 5, The cutoff on POD 7 was 668 pg/ml with a sensitivity of 60% and a specificity of 85%.
Conclusions: Presepsin levels on POD 5 and 7 after esophagectomy are a significant indicator of infectious complications detection compared with conventional biomarkers. The relationship between presepsin levels and the severity of complication or long-term outcomes are also needed in the future.