Presepsin Predicts 1-Year All-Cause Mortality Better Than N-Terminal Pro-B-Type Natriuretic Peptide in Patients Undergoing Transcatheter Aortic Valve Implantation

Abstract

Aim: Presepsin is a sensitive biomarker for the diagnosis and estimation of prognosis in septic patients. The prognostic role of presepsin in patients undergoing transcatheter aortic valve implantation (TAVI) has never been investigated. Patients, materials & methods: In 343 patients, presepsin and N-terminal pro-B-type natriuretic peptide were measured before TAVI. One-year all-cause mortality was used as outcome measure. Results: Patients with high presepsin levels were more likely to succumb than patients with low presepsin values (16.9% vs 12.3%; p = 0.015). Elevated presepsin remained a significant predictor of 1-year all-cause mortality (odds ratio: 2.2 [95% CI: 1.12–4.29]; p = 0.022) after adjustment. N-terminal pro-B-type natriuretic peptide did not predict 1-year all-cause mortality. Conclusion: Elevated baseline presepsin levels are an independent predictor of 1-year mortality in TAVI patients.

Plain language summary

Presepsin is a rather novel blood parameter that is most commonly used for the detection of severe infections. However, in patients without infections who are undergoing elective surgery, elevated baseline presepsin levels were also found to be associated with worse survival. In this study, researchers wanted to know whether increased presepsin levels can also predict worse survival in patients who are planned for transcatheter aortic valve implantation. To do so, they looked at the 1-year death rate of these patients and distinguished between low and high presepsin levels determined before the procedure. Patients with elevated presepsin levels before the procedure had a worse outcome after 1 year compared with those with low presepsin levels. Measurement of presepsin before the transcatheter aortic valve implantation procedure could help identify patients who are at a higher long-term risk, and accordingly a closer monitoring of these patients during the follow-up period might be warranted.

Keywords:

• aortic stenosis
• NT-proBNP
• presepsin
• soluble CD14
• TAVI

Author contributions

Substantial contributions to the conception or design of the work; acquisition, analysis or interpretation of data for the work; drafting of the work or revising it critically for important intellectual content; and final approval of the version to be published was made by all authors. The following authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: M Weferling, U Fischer-Rasokat, J Vietheer, M Renker, A Rolf, T Keller, Y-H Choi, M Arsalan, CW Hamm, W-K Kim, C Liebetrau.

Acknowledgements

The authors thank Elizabeth Martinson from the KHFI Editorial Office for her editorial assistance.

Financial & competing interests disclosure

The present analysis is based on cohorts that are part of the Kerckhoff Biomarker Registry (Bioreg), which is financially supported by the Kerckhoff Heart Research Institute (KHFI) and the German Center for Cardiovascular Research (DZHK). The sponsors had no influence on the study design, statistical analyses or drafting of the manuscript. M Renker received speaker fees from Abbott, CW Hamm contributes to the advisory board of Medtronic and W-K Kim received proctor/speaker honoraria from Abbott, Boston Scientific, Edwards Lifesciences and Medtronic. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval from the ethics committee of the Justus Liebig University of Giessen, Germany (FF 87/2010), and have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, informed consent has been obtained from the participants involved.