The perioperative presepsin as an accurate diagnostic marker of postoperative infectious complications after esophagecto
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ORIGINAL ARTICLE
The perioperative presepsin as an accurate diagnostic marker of postoperative infectious complications after esophagectomy: a prospective cohort study Masashi Takeuchi1 · Takahiro Yokose1 · Hirofumi Kawakubo1 · Satoru Matsuda1 · Shuhei Mayanagi1 · Tomoyuki Irino1 · Kazumasa Fukuda1 · Rieko Nakamura1 · Norihito Wada1 · Hideaki Obara1 · Yuko Kitagawa1 Received: 25 December 2019 / Accepted: 28 March 2020 © The Japan Esophageal Society 2020
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 postesophagectomy 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. Keywords Esophageal cancer · Esophagectomy · Presepsin
Introduction
Masashi Takeuchi and Takahiro Yokose contributed equally to this work. Disclaimer LSI Medience Corporation was not involved in the planning of the protocol, in conducting the trial or the analysis. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10388-020-00736-7) contains supplementary material, which is available to authorized users. * Hirofumi Kawakubo [email protected] 1
Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku‑ku, Tokyo 160‑8582, Japan
Despite recent improvements in surgical technique and perioperative management, esophagectomy for esophageal cancer patients remains a highly invasive procedure, resulting in high rates of postoperative complications. A Japanese nationwide web-based d
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