Dynamic blood presepsin levels are associated with severity and outcome of acute pancreatitis: A prospective cohort study

Table 1 Overall characteristics of the study population

Characteristic	Overall, n = 133	Mild, n = 95	Moderately severe, n = 21	Severe, n = 17	P value
Demographics
Male, %	86 (64.7)	56 (58.9)	16 (76.2)	14 (82.4)	0.086
Age, yr	65 (54.0-76.0)	65 (54.0-76.0)	68 (40.5-72.5)	59 (43.0-82.0)	0.860
Comorbidities
CHF, %	19 (17.4)	16 (18.8)	3 (18.8)	0 (0)	0.402
COPD, %	3 (2.8)	2 (2.4)	0 (0)	1 (12.5)	0.188
Diabetes, %	25 (22.9)	20 (23.5)	3 (18.8)	2 (25.0)	0.907
Immunosuppression, %	8 (7.3)	7 (8.2)	0 (0)	1 (12.5)	0.432
Etiology					0.003
Gallstones, %	84 (63.2)	65 (68.4)	12 (57.1)	7 (41.2)
Hypertryglyceridemia, %	12 (9.0)	9 (9.5)	0 (0)	3 (17.6)
Alcohol, %	4 (3.0)	2 (2.1)	2 (9.5)	0 (0)
Post-ERCP, %	15 (11.3)	13 (13.7)	1 (4.8)	1 (5.9)
Idiopathic, %	18 (13.5)	6 (6.3)	6 (28.6)	6 (35.3)
Scoring
BISAP score at admission	2.0 (1.0-2.0)	1.0 (1.0-2.0)	2.0 (2.0-3.0)	3.0 (2.0-3.0)	< 0.001
Ranson score at 48 h	2.0 (1.0-4.0)	2.0 (1.0-3.0)	3.0 (2.0-5.5)	4.0 (3.5-6.5)	< 0.001
CTSI score	4.0 (2.0-4.0)	2.0 (2.0-4.0)	4.0 (2.0-6.0)	4.0 (4.0-5.0)	0.002
APACHE II score at admission	8.0 (5.0-12.5)	7.0 (3.0-10.0)	9.0 (6.0-15.0)	18.0 (9.0-19.0)	< 0.001
Imaging
Pancreatic necrosis, %	14 (10.5)	5 (5.3)	6 (28.6)	3 (17.6)	0.013
Mechanical ventilation, %	3 (2.3)	0 (0)	0 (0)	3 (17.6)	< 0.001
CRRT, %	1 (0.8)	0 (0)	0 (0)	1 (5.9)	0.027
Length of hospital stay in d	11.74 ± 5.21	11.08 ± 3.73	13.24 ± 8.40	13.59 ± 6.72	0.067
Outcomes
Single organ failure, %	30 (22.6)	0 (0)	20 (95.2)	10 (58.8)	< 0.001
Multiple organ failure, %	8 (6.0)	0 (0)	1 (4.8)	7 (41.2)	< 0.001
28-d deaths, %	7 (5.3)	0 (0)	0 (0)	7 (41.2)	< 0.001
Cost in $	5276.14 (3265.34-7739.10)	4482.18 (3127.06-6493.38)	7242.67 (3356.87-8785.31)	11222.04 (7457.31-23045.12)	< 0.001

Data are presented as mean ± SD, n (%), or median (25^th-75^th percentile). CHF: Chronic heart failure; COPD: Chronic obstructive pulmonary disease; BISAP: Bedside index of severity in acute pancreatitis; CTSI: Computed tomography severity index; APACHE: Acute physiology and chronic health evaluation; CRRT: Continuous renal replacement therapy; ERCP: Endoscopic retrograde cholangiopancreatography.

Table 2 Independent factors for time-specific prediction of non-mild (moderately severe and severe) acute pancreatitis

Variable	β	Standard error	Wald statistic	Degrees of freedom	P value	Odds ratio	95%CI
							Lower limit	Upper limit
Non-mild AP day 1
Etiology	0.456	0.133	11.707	1	0.001	1.578	1.215	2.050
Presepsin day 1	0.000	0.000	5.872	1	0.015	1.001	1.000	1.001
Non-mild AP day 3
Etiology	0.259	0.178	2.115	1	0.146	1.296	0.914	1.836
Presepsin day 3	0.001	0.000	8.567	1	0.003	1.001	1.000	1.001
Non-mild AP day 5
Etiology	0.315	0.199	2.502	1	0.114	1.371	0.927	2.026
Presepsin day 5	0.002	0.000	13.141	1	< 0.001	1.002	1.001	1.003
Non-mild AP day 7
Etiology	0.292	0.215	1.836	1	0.175	1.339	0.878	2.041
Presepsin day 7	0.002	0.000	13.203	1	< 0.001	1.002	1.001	1.003

AP: Acute pancreatitis.

Table 3 Time-specific area under the receiver operating characteristic curve of presepsin for prediction of moderately severe and severe acute pancreatitis

Time point	Cutoff (pg/mL)	Sensitivity	Specificity	PPV	NPV	AUROC (95%CI)	P value
Day 3	657.5	92.9%	71.4%	76.5%	90.9%	0.827 (0.730-0.923)	< 0.001
Day 5	593.5	84.6%	80.4%	81.2%	83.9%	0.848 (0.751-0.945)	< 0.001
Day 7	601.5	72.7%	89.8%	87.7%	76.7%	0.867 (0.756-0.977)	< 0.001

AUROC: Area under the receiver operating characteristic curve; NPV: Negative predictive value; PPV: Positive predictive value.

Table 4 Correlation between presepsin and procalcitonin or C-reactive protein levels

Variables	Procalcitonin	C-reactive protein
Presepsin day 1	r = 0.464	r = 0.179
	P < 0.001	P = 0.080
Presepsin day 3	r = 0.318	r = 0.254
	P = 0.002	P = 0.016
Presepsin day 5	r = 0.208	r = 0.183
	P = 0.084	P = 0.091
Presepsin day 7	r = 0.239	r = 0.312
	P = 0.053	P = 0.007

Table 5 Comparison of clinical characteristics between survival and non-survival groups

Characteristic	28-d survival outcome		P value
	Survival (n = 126)	Non-survival (n = 7)
Demographics
Male, %	79 (62.7)	7 (100.0)	0.051
Age, yr	65 (54-75)	75 (54-82)	0.417
Comorbidities
CHF, %	19 (18.1)	0 (0)	1.000
COPD, %	2 (1.9)	1 (25.0)	0.107
Diabetes, %	24 (22.9)	1 (25.0)	1.000
Immunosuppression, %	7 (6.7)	1 (25.0)	0.266
Etiology			0.634
Gallstones, %	80 (63.5)	4 (57.1)
Hypertryglyceridemia, %	11 (8.7)	1 (14.3)
Alcohol, %	4 (3.2)	0 (0.0)
Post-ERCP, %	15 (11.9)	0 (0.0)
Idiopathic, %	16 (12.7)	2 (28.6)
Scoring
BISAP score at admission	1.0 (1.0-2.0)	3.0 (2.0-4.0)	0.003
Ranson score at 48 h	2.0 (1.0-3.0)	5.0 (4.0-8.0)	< 0.001
CTSI score	2.0 (2.0-4.0)	4.0 (4.0-4.0)	0.181
APACHE II score at admission	8.0 (4.8-11.0)	19.0 (15.0-31.0)	< 0.001
Imaging
Pancreatic necrosis, %	13 (10.3)	1 (14.3)	0.550
Mechanical ventilation, %	0 (0.0)	3 (42.9)	< 0.001
CRRT, %	0 (0.0)	1 (14.3)	0.053
Length of hospital stay in d	11 (9-14)	13 (5-21)	0.568
Outcomes
Single organ failure, %	27 (22.1)	3 (100.0)	0.013
Multiple organ failure, %	4 (4.0)	4 (100.0)	< 0.001
Cost in $	4718.99 (3065.47-7104.78)	22243.29 (10432.63-36309.99)	0.001

Data are presented as n (%), or median (25^th-75^th percentile). CHF: Chronic heart failure; COPD: Chronic obstructive pulmonary disease; ERCP: Endoscopic retrograde cholangiopancreatography; BISAP: Bedside index of severity in acute pancreatitis; CTSI: Computed tomography severity index; APACHE: Acute physiology and chronic health evaluation; CRRT: Continuous renal replacement therapy.

Table 6 Independent factors for the prediction of 28-d mortality in patients with acute pancreatitis

Variable	β	Standard error	Wald statistic	Degrees of freedom	P value	Odds ratio	95%CI
							Lower limit	Upper limit
Presepsin day 3	0.001	0.000	5.013	1	0.025	1.001	1.000	1.001
Presepsin day 5	0.002	0.000	11.406	1	0.001	1.002	1.001	1.003
Presepsin day 7	0.002	0.001	11.672	1	0.001	1.002	1.001	1.003
BISAP score at admission	1.217	0.390	9.700	1	0.002	3.376	1.571	7.255
Ranson score at 48 h	0.868	0.249	12.202	1	< 0.001	2.383	1.464	3.880
APACHE II score at admission	0.477	0.166	8.251	1	0.004	1.611	1.164	2.230

BISAP: Bedside index of severity in acute pancreatitis; APACHE: Acute physiology and chronic health evaluation.