Diagnostic Agreement of Presepsin, Procalcitonin, C-Reactive Protein and White Blood Cell Count in Patients with Suspected Sepsis

Intoduction/Aim. Agreement or disagreement of inflammatory parameters becomes important for making diagnosis when disparate values are encountered in a patient with suspected sepsis. The aim of our study was to test the agreement between the four commonly used tests for diagnosing systemic infection: white blood cell count (WBC), serum levels of C-reactive protein (CRP), procalcitonin and presepsin. Methods. This cross-sectional study included 479 adult patients hospitalized in the Clinical Center Kragujevac during 2019, who were suspected to have systemic infection and whose microbiological analyses were positive. Results. In a sample of hospital patients with isolated bacteria from the sites of suspected infection, the parameters of inflammation showed low agreement when used for diagnosing systemic infection. Only presepsin serum levels showed significant level of agreement with CRP and procalcitonin (Cohen's kappa = 0,257, p = 0,000Cohen's kappa = 0,169, p = 0,000, respectively, but also with low kappa values, while the agreement between CRP and procalcitonin was insignificant, as well as between the white cell count and the remaining three parameters. Conclusions. When disparate values of parameters of inflammation are encountered in a patient with suspected sepsis, a decision about antibiotic therapy should be based on either of the two pairs of parameters, presepsin/C-reactive protein or presepsin/procalcitonin.