Early Differential Value of Plasma Presepsin on Infection of Trauma Patients

OBJECTIVE: Early differential diagnosis of an infection in a trauma patient is likely to have a significant influence on the prognosis. In the present study, we evaluated the early differential value of plasma presepsin, procalcitonin (PCT), C-reactive protein (CRP), and white blood cells (WBCs) on infection in trauma patients. METHODS: Trauma patients were divided into noninfected (n = 89) and infected trauma groups (n = 68); healthy adult volunteers (n = 60) and patients having sterile surgery (n = 60) were enrolled as the controls. Plasma presepsin, PCT, CRP, and WBC counts were measured and the injury severity score (ISS) was calculated. RESULTS: Plasma presepsin levels within the first 3 d of admission were only significantly increased in the infected trauma group, but not in the noninfected trauma and sterile groups. This indicated that presepsin might have an ability to differentiate the infection in trauma patients; however, plasma PCT, CRP, and WBCs were significantly increased in both the infected and noninfected trauma patients. Binary logistic regression analysis showed that only increased plasma presepsin, PCT, and ISS were significantly associated with an increased likelihood of infection in trauma patients. Both presepsin and PCT were valuable for diagnosing infection; presepsin had a higher area under the curve than PCT. CONCLUSION: Presepsin might be a superior biomarker for early differentiation of infection in trauma patients; however, trauma stress elevates PCT, CRP, and WBCs even in the absence of infection; therefore, caution is advised when using these indicators to diagnose infection.