Role of Presepsin in Cirrhosis: A Potential Marker of Infections and Decompensation Events in Cirrhotic Patients

Liver cirrhosis is still one of the leading causes of death in the Western world. Although viral agents have been eradicated or controlled by antiviral drugs, metabolic dysfunction and toxic compounds are emerging as pivotal factors in liver dysfunction. Moreover, acute events such as infections can lead to cirrhosis decompensation and acute-on-chronic liver failure, thus increasing hospitalization and both short- and long-term mortality rates. Therefore, early diagnosis and prompt treatment of both infections and decompensation events represent the primary goal for preventing acute deterioration and reducing the overall mortality rate in this fragile population. However, in clinical practice, this remains challenging. Currently, highly effective non-invasive diagnostic and prognostic markers of infection and decompensation have not been definitively identified, even though several molecules have been proposed (eg, presepsin, monocyte distribution width, C-reactive protein, procalcitonin). In this literature review, we focus specifically on the role of presepsin as a potential marker of infections and decompensation events in cirrhotic patients, as its role in the early diagnosis of sepsis has already been established in non-cirrhotic populations. Nevertheless, clinical trials and strong literary evidence regarding presepsin in the cirrhotic population are still scarce, but we hope that in the future, this molecule may serve to guide clinicians in therapeutic choices within a hospital setting.