Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter November 25, 2017

Diagnostic and prognostic value of presepsin vs. established biomarkers in critically ill patients with sepsis or systemic inflammatory response syndrome

  • Helena Brodska , Jiri Valenta , Kveta Pelinkova , Zdenek Stach , Robert Sachl , Martin Balik , Tomas Zima and Tomas Drabek EMAIL logo



Inflammatory biomarkers may aid to distinguish between systemic inflammatory response syndrome (SIRS) vs. sepsis. We tested the hypotheses that (1) presepsin, a novel biomarker, can distinguish between SIRS and sepsis, and (2) higher presepsin levels will be associated with increased severity of illness and (3) with 28-day mortality, outperforming traditional biomarkers.


Procalcitonin (PCT), C-reactive protein (CRP), presepsin, and lactate were analyzed in 60 consecutive patients (sepsis and SIRS, n=30 per group) on day 1 (D1) to D3 (onset sepsis, or after cardiac surgery). The systemic organ failure assessment (SOFA) score was determined daily.


There was no difference in mortality in sepsis vs. SIRS (12/30 vs. 8/30). Patients with sepsis had higher SOFA score vs. patients with SIRS (11±4 vs. 8±5; p=0.023), higher presepsin (AUC=0.674; p<0.021), PCT (AUC=0.791; p<0.001), CRP (AUC=0.903; p<0.0001), but not lactate (AUC=0.506; p=0.941). Unlike other biomarkers, presepsin did not correlate with SOFA on D1. All biomarkers were associated with mortality on D1: presepsin (AUC=0.734; p=0.0006; best cutoff=1843 pg/mL), PCT (AUC=0.844; p<0.0001), CRP (AUC=0.701; p=0.0048), and lactate (AUC=0.778; p<0.0001). Multiple regression analyses showed independent associations of CRP with diagnosis of sepsis, and CRP and lactate with mortality. Increased neutrophils (p=0.002) and decreased lymphocytes (p=0.007) and monocytes (p=0.046) were also associated with mortality.


Presepsin did not outperform traditional sepsis biomarkers in diagnosing sepsis from SIRS and in prognostication of mortality in critically ill patients. Presepsin may have a limited adjunct value for both diagnosis and an early risk stratification, performing independently of clinical illness severity.

Corresponding author: Tomas Drabek, MD, PhD, Department of Anesthesiology, University of Pittsburgh School of Medicine, UPMC Presbyterian Hospital, 200 Lothrop St. Suite C220, Pittsburgh, PA 15213, USA, Phone: +(1) 412-647-1687

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: Supported by the Research Project PROGRES Q 25 of the Charles University in Prague, Czech Republic, by RVO VFN 64165 of the General University Hospital in Prague, Czech Republic, and by the European Union’s Horizon 2020 Research and Innovation Programme under grant agreement no. 687697 (

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


1. Stevenson EK, Rubenstein AR, Radin GT, Wiener RS, Walkey AJ. Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis*. Crit Care Med 2014;42:625–31.10.1097/CCM.0000000000000026Search in Google Scholar

2. Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 2006;34:344–53.10.1097/01.CCM.0000194725.48928.3ASearch in Google Scholar

3. Laszlo I, Trasy D, Molnar Z, Fazakas J. Sepsis: from pathophysiology to individualized patient care. J Immunol Res 2015;2015:510436.10.1155/2015/510436Search in Google Scholar

4. Wacker C, Prkno A, Brunkhorst FM, Schlattmann P. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis 2013;13:426–35.10.1016/S1473-3099(12)70323-7Search in Google Scholar

5. Trasy D, Molnar Z. Procalcitonin – assisted antibiotic strategy in sepsis. EJIFCC 2017;28:104–13.Search in Google Scholar

6. Ackland GL, Prowle JR. Presepsin: solving a soluble (CD14) problem in sepsis? Intensive Care Med 2015;41:351–3.10.1007/s00134-014-3642-8Search in Google Scholar PubMed

7. de Guadiana Romualdo LG, Torrella PE, Acebes SR, Oton MD, Sanchez RJ, Holgado AH, et al. Diagnostic accuracy of presepsin (sCD14-ST) as a biomarker of infection and sepsis in the emergency department. Clin Chim Acta 2017;464:6–11.10.1016/j.cca.2016.11.003Search in Google Scholar PubMed

8. Romualdo LG, Torrella PE, Gonzalez MV, Sanchez RJ, Holgado AH, Freire AO, et al. Diagnostic accuracy of presepsin (soluble CD14 subtype) for prediction of bacteremia in patients with systemic inflammatory response syndrome in the Emergency Department. Clin Biochem 2014;47:505–8.10.1016/j.clinbiochem.2014.02.011Search in Google Scholar PubMed

9. Ulla M, Pizzolato E, Lucchiari M, Loiacono M, Soardo F, Forno D, et al. Diagnostic and prognostic value of presepsin in the management of sepsis in the emergency department: a multicenter prospective study. Crit Care 2013;17:R168.10.1186/cc12847Search in Google Scholar PubMed PubMed Central

10. Behnes M, Bertsch T, Lepiorz D, Lang S, Trinkmann F, Brueckmann M, et al. Diagnostic and prognostic utility of soluble CD 14 subtype (presepsin) for severe sepsis and septic shock during the first week of intensive care treatment. Crit Care 2014;18:507.10.1186/s13054-014-0507-zSearch in Google Scholar PubMed PubMed Central

11. Endo S, Suzuki Y, Takahashi G, Shozushima T, Ishikura H, Murai A, et al. Presepsin as a powerful monitoring tool for the prognosis and treatment of sepsis: a multicenter prospective study. J Infect Chemother 2014;20:30–4.10.1016/j.jiac.2013.07.005Search in Google Scholar PubMed

12. Matera G, Quirino A, Peronace C, Settembre P, Marano V, Loria MT, et al. Soluble CD14 subtype-a new biomarker in predicting the outcome of critically Ill septic patients. Am J Med Sci 2017;353:543–51.10.1016/j.amjms.2017.03.036Search in Google Scholar PubMed

13. Kim H, Hur M, Moon HW, Yun YM, Di Somma S, Network G. Multi-marker approach using procalcitonin, presepsin, galectin-3, and soluble suppression of tumorigenicity 2 for the prediction of mortality in sepsis. Ann Intensive Care 2017;7:27.10.1186/s13613-017-0252-ySearch in Google Scholar PubMed PubMed Central

14. Yu H, Qi Z, Hang C, Fang Y, Shao R, Li C. Evaluating the value of dynamic procalcitonin and presepsin measurements for patients with severe sepsis. Am J Emerg Med 2017;35:835–41.10.1016/j.ajem.2017.01.037Search in Google Scholar PubMed

15. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992;20:864–74.10.1097/00003246-199206000-00025Search in Google Scholar

16. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11:R31.10.1186/cc5713Search in Google Scholar PubMed PubMed Central

17. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. Report of the American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes and clinical trial coordination. The Consensus Committee. Intensive Care Med 1994;20:225–32.10.1007/BF01704707Search in Google Scholar PubMed

18. Force AD, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, et al. Acute respiratory distress syndrome: the Berlin Definition. J Am Med Assoc 2012;307:2526–33.Search in Google Scholar

19. Giavarina D, Carta M. Determination of reference interval for presepsin, an early marker for sepsis. Biochem Med (Zagreb) 2015;25:64–8.10.11613/BM.2015.007Search in Google Scholar PubMed PubMed Central

20. Vodnik T, Kaljevic G, Tadic T, Majkic-Singh N. Presepsin (sCD14-ST) in preoperative diagnosis of abdominal sepsis. Clin Chem Lab Med 2013;51:2053–62.10.1515/cclm-2013-0061Search in Google Scholar PubMed

21. Sargentini V, Ceccarelli G, D’Alessandro M, Collepardo D, Morelli A, D’Egidio A, et al. Presepsin as a potential marker for bacterial infection relapse in critical care patients. A preliminary study. Clin Chem Lab Med 2015;53:567–73.10.1515/cclm-2014-0119Search in Google Scholar PubMed

22. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988;44:837–45.10.2307/2531595Search in Google Scholar

23. Metz CE. Basic principles of ROC analysis. Semin Nucl Med 1978;8:283–98.10.1016/S0001-2998(78)80014-2Search in Google Scholar

24. Filho RR, Rocha LL, Correa TD, Pessoa CM, Colombo G, Assuncao MS. Blood lactate levels cutoff and mortality prediction in sepsis-time for a reappraisal? a retrospective cohort study. Shock 2016;46:480–5.10.1097/SHK.0000000000000667Search in Google Scholar PubMed PubMed Central

25. Liu D, Su L, Han G, Yan P, Xie L. Prognostic value of procalcitonin in adult patients with sepsis: a systematic review and meta-analysis. PLoS One 2015;10:e0129450.10.1371/journal.pone.0129450Search in Google Scholar PubMed PubMed Central

26. Ryu JA, Yang JH, Lee D, Park CM, Suh GY, Jeon K, et al. Clinical usefulness of procalcitonin and C-reactive protein as outcome predictors in critically Ill patients with severe sepsis and septic shock. PLoS One 2015;10:e0138150.10.1371/journal.pone.0138150Search in Google Scholar PubMed PubMed Central

27. Chenevier-Gobeaux C, Borderie D, Weiss N, Mallet-Coste T, Claessens YE. Presepsin (sCD14-ST), an innate immune response marker in sepsis. Clin Chim Acta 2015;450:97–103.10.1016/j.cca.2015.06.026Search in Google Scholar PubMed

28. Zheng Z, Jiang L, Ye L, Gao Y, Tang L, Zhang M. The accuracy of presepsin for the diagnosis of sepsis from SIRS: a systematic review and meta-analysis. Ann Intensive Care 2015;5:48.10.1186/s13613-015-0089-1Search in Google Scholar PubMed PubMed Central

29. Wu J, Hu L, Zhang G, Wu F, He T. Accuracy of presepsin in sepsis diagnosis: a systematic review and meta-analysis. PLoS One 2015;10:e0133057.10.1371/journal.pone.0133057Search in Google Scholar PubMed PubMed Central

30. Tong X, Cao Y, Yu M, Han C. Presepsin as a diagnostic marker for sepsis: evidence from a bivariate meta-analysis. Ther Clin Risk Manag 2015;11:1027–33.10.2147/TCRM.S84811Search in Google Scholar PubMed PubMed Central

31. Hayashida K, Kondo Y, Hara Y, Aihara M, Yamakawa K. Head-to-head comparison of procalcitonin and presepsin for the diagnosis of sepsis in critically ill adult patients: a protocol for a systematic review and meta-analysis. BMJ Open 2017;7:e014305.10.1136/bmjopen-2016-014305Search in Google Scholar PubMed PubMed Central

32. Godnic M, Stubljar D, Skvarc M, Jukic T. Diagnostic and prognostic value of sCD14-ST–presepsin for patients admitted to hospital intensive care unit (ICU). Wien Klin Wochenschr 2015;127:521–7.10.1007/s00508-015-0719-5Search in Google Scholar PubMed

33. Ali FT, Ali MA, Elnakeeb MM, Bendary HN. Presepsin is an early monitoring biomarker for predicting clinical outcome in patients with sepsis. Clin Chim Acta 2016;460:93–101.10.1016/j.cca.2016.06.030Search in Google Scholar PubMed

34. Leli C, Ferranti M, Marrano U, Al Dhahab ZS, Bozza S, Cenci E, et al. Diagnostic accuracy of presepsin (sCD14-ST) and procalcitonin for prediction of bacteraemia and bacterial DNAaemia in patients with suspected sepsis. J Med Microbiol 2016;65:713–9.10.1099/jmm.0.000278Search in Google Scholar PubMed

35. Klouche K, Cristol JP, Devin J, Gilles V, Kuster N, Larcher R, et al. Diagnostic and prognostic value of soluble CD14 subtype (Presepsin) for sepsis and community-acquired pneumonia in ICU patients. Ann Intensive Care 2016;6:59.10.1186/s13613-016-0160-6Search in Google Scholar PubMed PubMed Central

36. Enguix-Armada A, Escobar-Conesa R, Garcia-De La Torre A, De La Torre-Prados MV. Usefulness of several biomarkers in the management of septic patients: C-reactive protein, procalcitonin, presepsin and mid-regional pro-adrenomedullin. Clin Chem Lab Med 2016;54:163–8.10.1515/cclm-2015-0243Search in Google Scholar PubMed

37. Kweon OJ, Choi JH, Park SK, Park AJ. Usefulness of presepsin (sCD14 subtype) measurements as a new marker for the diagnosis and prediction of disease severity of sepsis in the Korean population. J Crit Care 2014;29:965–70.10.1016/j.jcrc.2014.06.014Search in Google Scholar PubMed

38. Masson S, Caironi P, Spanuth E, Thomae R, Panigada M, Sangiorgi G, et al. Presepsin (soluble CD14 subtype) and procalcitonin levels for mortality prediction in sepsis: data from the Albumin Italian Outcome Sepsis trial. Crit Care 2014;18:R6.10.1186/cc13183Search in Google Scholar PubMed PubMed Central

39. Chenevier-Gobeaux C, Trabattoni E, Roelens M, Borderie D, Claessens YE. Presepsin (sCD14-ST) in emergency department: the need for adapted threshold values? Clin Chim Acta 2014;427:34–6.10.1016/j.cca.2013.09.019Search in Google Scholar PubMed

40. Nagata T, Yasuda Y, Ando M, Abe T, Katsuno T, Kato S, et al. Clinical impact of kidney function on presepsin levels. PLoS One 2015;10:e0129159.10.1371/journal.pone.0129159Search in Google Scholar PubMed PubMed Central

41. Takahashi G, Shibata S, Fukui Y, Okamura Y, Inoue Y. Diagnostic accuracy of procalcitonin and presepsin for infectious disease in patients with acute kidney injury. Diagn Microbiol Infect Dis 2016;86:205–10.10.1016/j.diagmicrobio.2016.07.015Search in Google Scholar PubMed

42. Honore PM, Jacobs R, Hendrickx I, De Waele E, Van Gorp V, Spapen HD. Presepsin and sepsis-induced acute kidney injury treated with continuous renal replacement therapy: will another promising biomarker bite the dust? Crit Care 2015;19:428.10.1186/s13054-015-1146-8Search in Google Scholar PubMed PubMed Central

43. Bomberg H, Klingele M, Wagenpfeil S, Spanuth E, Volk T, Sessler DI, et al. Presepsin (sCD14-ST) is a novel marker for risk stratification in cardiac surgery patients. Anesthesiology 2017;126:631–42.10.1097/ALN.0000000000001522Search in Google Scholar PubMed

44. Aouifi A, Piriou V, Bastien O, Blanc P, Bouvier H, Evans R, et al. Usefulness of procalcitonin for diagnosis of infection in cardiac surgical patients. Crit Care Med 2000;28:3171–6.10.1097/00003246-200009000-00008Search in Google Scholar PubMed

45. Sponholz C, Sakr Y, Reinhart K, Brunkhorst F. Diagnostic value and prognostic implications of serum procalcitonin after cardiac surgery: a systematic review of the literature. Crit Care 2006;10:R145.10.1186/cc5067Search in Google Scholar PubMed PubMed Central

46. Trasy D, Tanczos K, Nemeth M, Hankovszky P, Lovas A, Mikor A, et al. Delta procalcitonin is a better indicator of infection than absolute procalcitonin values in critically Ill patients: a prospective observational study. J Immunol Res 2016;2016:3530752.10.1155/2016/3530752Search in Google Scholar PubMed PubMed Central

47. Shankar-Hari M, Harrison DA, Rubenfeld GD, Rowan K. Epidemiology of sepsis and septic shock in critical care units: comparison between sepsis-2 and sepsis-3 populations using a national critical care database. Br J Anaesth 2017;119:626–36.10.1093/bja/aex234Search in Google Scholar PubMed

48. Sterling SA, Puskarich MA, Glass AF, Guirgis F, Jones AE. The impact of the sepsis-3 septic shock definition on previously defined septic shock patients. Crit Care Med 2017;45:1436–42.10.1097/CCM.0000000000002512Search in Google Scholar PubMed PubMed Central

Supplemental Material:

The online version of this article offers supplementary material (

Received: 2017-9-15
Accepted: 2017-10-22
Published Online: 2017-11-25
Published in Print: 2018-3-28

©2018 Walter de Gruyter GmbH, Berlin/Boston

Downloaded on 1.4.2023 from
Scroll to top button