This study systematically evaluated the diagnostic value of multiple biomarkers in severe burn patients, where presepsin demonstrated superior performance in culture-negative cases and showed potential for guiding antibiotic use. Additionally, the study illustrated the clinical utility of presepsin through decision curve analysis and reclassification metrics.
Literature Overview
This article, 'Diagnostic Accuracy of Presepsin and Its Impact on Early Antibiotic De-Escalation in Burn-Related Sepsis', published in the journal Antibiotics, reviews biomarker performance related to early antibiotic de-escalation and sepsis diagnosis in severe burn patients. It examines the diagnostic utility of presepsin, procalcitonin, and CRP in burn patients while analyzing their performance differences between culture-positive and culture-negative sepsis. The study emphasizes presepsin's value in antibiotic management, particularly in culture-negative scenarios, providing theoretical support for reducing broad-spectrum antibiotic use.
Background Knowledge
Severe burn patients face high sepsis risks due to compromised skin barriers and immunosuppression, often complicated by culture-negative presentations that challenge clinical diagnosis and treatment. Traditional biomarkers like CRP and procalcitonin exhibit limited specificity in burn populations, necessitating more reliable indicators. Presepsin, a CD14 receptor cleavage product, offers earlier detection of immune activation following pathogen exposure, making it theoretically valuable for burn-related sepsis diagnosis. The study further incorporates decision curve analysis and reclassification metrics to evaluate clinical utility of biomarker combinations. While existing evidence supports presepsin's role in antibiotic management for non-burn populations, its performance in burn patients lacked systematic evaluation. This study fills this gap, providing clinicians with enhanced diagnostic tools and supporting optimized antibiotic management strategies.
Research Methods and Experiments
This prospective diagnostic accuracy study enrolled 221 severe burn patients, collecting blood culture samples and biomarker tests simultaneously upon clinical suspicion of sepsis. Optimal cutoff values were determined using the Youden index, with diagnostic performance evaluated through ROC curve area under the curve (AUC). Clinical utility was further assessed via decision curve analysis and net reclassification improvement (NRI). The study specifically analyzed presepsin's performance in culture-positive versus culture-negative sepsis and evaluated its role in mortality prediction.
Key Conclusions and Perspectives
Research Significance and Prospects
This study provides novel biomarker evidence for sepsis diagnosis in severe burn patients, particularly presepsin's advantages in culture-negative scenarios. Future research should incorporate multidrug-resistant and mixed infection scenarios to refine presepsin's clinical application. It also recommends validating presepsin thresholds in broader populations and exploring implementation pathways for antimicrobial stewardship.
Conclusion
This study systematically evaluated the diagnostic accuracy and clinical utility of presepsin and other biomarkers in burn-related sepsis. Presepsin demonstrated superior AUC in culture-negative cases with rapid kinetic response supporting early diagnosis. Results highlight early antibiotic administration as a primary cause of culture-negative sepsis, while presepsin maintains diagnostic reliability post-exposure. Combined with decision curve analysis and survival prediction models, presepsin offers potential strategies for antibiotic de-escalation and establishes foundations for personalized antimicrobial management. These findings hold significant implications for improving sepsis diagnostic efficiency in burn ICUs and optimizing antibiotic utilization.
