Diagnostic and prognostic value of presepsin in sepsis patients: a follow-up observational study

Abstract Background Sepsis is a major global healthcare challenge with high morbidity, mortality, and economic burden. Early recognition is difficult because initial symptoms may be vague, and no single biomarker provides a definitive diagnosis. While current guidelines emphasize organ dysfunction scores, Systemic Inflammatory Response Syndrome (SIRS) criteria remain utilized globally as a sensitive screening tool despite its limited specificity. Therefore, this study evaluates the diagnostic and prognostic value of presepsin in confirmed sepsis patients as an accessible and cost-effective biomarker. Methods The study initially included 100 patients meeting SIRS criteria and 30 healthy controls. Twenty-four patients were excluded from the analysis: four due to a lack of confirmed infection based on clinical, laboratory, microbiological, and radiological findings, and twenty due to missing Day 3 blood samples during routine care. The remaining 76 patients were followed for 28-day outcomes, with 57 survivors and 19 deaths. Cultures were performed at admission, while serum presepsin and other biomarkers were assessed at baseline and on Day 3. Sequential Organ Failure Assessment (SOFA) and quick (SOFA) scores were calculated on admission. Results In this study, baseline presepsin was higher in patients than controls (500 vs. 65 ng/L, P  < 0.0001). Presepsin differentiated sepsis from controls with an area under the curve (AUC) = 1.000. A cutoff > 90 ng/L achieved 100% sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Univariate analysis linked SOFA (OR = 2.009, P =  0.000) and Day 3 presepsin (OR = 1.002, P =  0.024) to 28-day mortality, unlike creatinine and lactate. In multivariate analysis, only SOFA independently predicted mortality (OR = 2.049, P =  0.001). Conclusions Presepsin showed potential value as an adjunctive biomarker for sepsis assessment and prognostic evaluation. At a cutoff > 90 ng/L, Presepsin demonstrates perfect performance distinguishing sepsis patients from controls. Admission presepsin did not differentiate between culture-positive and culture-negative patients. Higher Day 3 presepsin, lactate, and SOFA scores were associated with 28-day mortality. In multivariate analysis, higher SOFA scores independently predicted 28-day mortality.