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The perioperative presepsin as an accurate diagnostic marker of postoperative infectious complications after esophagectomy: a prospective cohort study

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Abstract

Background

Presepsin is suggested to be an accurate sepsis diagnostic biomarker, playing an important role in distinguishing infection from no-infection status. However, to date, there is no study determining presepsin’s role in diagnosing post-esophagectomy infectious complications.

Methods

Thirty patients who underwent esophagectomy for esophageal carcinoma were included in this prospective observational study. We investigated preoperative presepsin levels’ changes and evaluated the relationship between infectious complications and presepsin levels. Moreover, we analyzed the classification and regression tree (CART) to determine presepsin’s optimal cutoff values for discriminating infectious complications.

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-surgery, and 1, 2, 3, 5, 7 days post-surgery, respectively. Presepsin levels were significantly higher in the infectious complication group exclusively from preoperation to POD 7 (p = 0.048). Furthermore, area under the curve’s value of presepsin on POD 5 and 7 was higher than the other three biomarkers included for discriminating infectious complications (i.e., procalcitonin, leukocyte, and C-reacted protein). We set an optimal cutoff value for presepsin calculated by CART. Specifically, on POD 5, the cutoff was 888 pg/ml with a sensitivity of 60% and a specificity of 90%, and on POD 7, the cutoff 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 valuable indicator of infectious complication’s detection vs. leukocyte, C-reacted protein, and procalcitonin.

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Acknowledgements

The authors thank Kumiko Motooka, a staff member at the Department of Surgery in Keio University School of Medicine, for her help in preparing this manuscript. We also thank Kaili Chen for excellent help for sample collections.

Funding

This work was supported by donations from the Department of Surgery, Keio University School of Medicine and LSI Medience Corporation.

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Author notes

  1. Masashi Takeuchi and Takahiro Yokose contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Masashi Takeuchi, Takahiro Yokose, Hirofumi Kawakubo, Satoru Matsuda, Shuhei Mayanagi, Tomoyuki Irino, Kazumasa Fukuda, Rieko Nakamura, Norihito Wada, Hideaki Obara & Yuko Kitagawa

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  1. Masashi Takeuchi
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  2. Takahiro Yokose
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  3. Hirofumi Kawakubo
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Contributions

Masashi Takeuchi and Takahiro Yokose contributed equally to this study.

Corresponding author

Correspondence to Hirofumi Kawakubo.

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Ethical Statement

Study protocol was first approved by the Institutional Review Board of Keio University School of Medicine.

Conflict of interest

Yuko Kitagawa received grant support from TAIHO PHARMACEUTICAL CO., LTD, CHUGAI PHARMACEUTICAL CO., LTD., Yakult Honsha Co. Ltd., DAIICHI SANKYO COMPANY, LIMITED, Merck Serono Co., Ltd., AsahiKASEI Co., Ltd., EA Pharma Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Factory Inc., SHIONOGI & CO., LTD. KAKEN PHARMACEUTICAL CO., LTD., Kowa Pharmaceutical Co., Ltd., Astellas Pharma Inc., MEDICON INC., DAINIPPON SUMITOMO PHARMA Co., Ltd., Taisho Toyama Pharmaceutical Co., Ltd., Kyouwa Hakkou Kirin Co., Ltd., Pfizer Japan Inc., ONO PHARMACEUTICAL CO., LTD., NIHON PHARMACEUTICAL CO., LTD., Japan Blood Products Organization, Medtronic Japan Co., Ltd., Sanofi K.K., grants from Eisai Co., Ltd. TSUMURA & CO., KCI Licensing, Inc., ABBOTT JAPAN CO., LTD., FUJIFILM Toyama Chemical Co., Ltd.

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LSI Medience Corporation was not involved in the planning of the protocol, in conducting the trial or the analysis.

Electronic supplementary material

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10388_2020_736_MOESM1_ESM.eps

Supplemental Figure 1 Box plot of the perioperative change of presepsin (a), procalcitonin (b), leukocyte (c), and C-reacted protein (d) in non-complications patients undergoing esophagectomy. Left side; patients with thoracotomy, middle side; patients with video-assisted thoracic surgery (VATS) right side; patients with robot-assisted thoracic surgery (RATS) (EPS 4446 kb)

10388_2020_736_MOESM2_ESM.eps

Supplemental Figure 2 Box plot of the perioperative change of presepsin (a), procalcitonin (b), leukocyte (c), and C-reacted protein (d) in non-complications patients undergoing esophagectomy. Left side; patients with non-neoadjuvant, right side; patients with neoadjuvant (EPS 4462 kb)

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Takeuchi, M., Yokose, T., Kawakubo, H. et al. The perioperative presepsin as an accurate diagnostic marker of postoperative infectious complications after esophagectomy: a prospective cohort study. Esophagus 17, 399–407 (2020). https://doi.org/10.1007/s10388-020-00736-7

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  • DOI: https://doi.org/10.1007/s10388-020-00736-7

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