Diagnostic significance of presepsin (sCD14-ST) in comparative evaluation with procalcitonin and C-reactive protein in patients with suspected sepsis

Introduction. Early and accurate diagnosis of sepsis in patients in intensive care units is critically important. Therefore, it is important to search for biomarkers with high diagnostic and prognostic significance.

Aim. To assess the significance of presepsin (sCD14-ST) in comparison with procalcitonin (PCT) and C-reactive protein (CRP) in patients with clinical signs of a systemic inflammatory response and suspected sepsis.

Materials and methods. A retrospective analysis of the data of 142 patients admitted to the intensive care unit (ICU) of a multidisciplinary hospital in the period from January to December 2025 was carried out. The diagnosis of sepsis was verified according to Sepsis-3 criteria (SOFA ≥ 2 points in the presence of confirmed or suspected infection). The levels of presepsin, PCT and CRP were determined in blood plasma in the first 24 hours after admission. The diagnostic accuracy of biomarkers was assessed by ROC analysis with the calculation of area under the curve (AUC), sensitivity, specificity, positive and negative likelihood ratios.

Results. Of the 142 patients examined, 98 (69.0%) met the criteria for sepsis, 44 (31.0%) had non-infectious systemic inflammatory response syndrome (SIRS). The median presepsin concentration in the sepsis group was 1,284 pg/ml, which was significantly higher than in the non-infectious CVD group (386 pg/ml, p < 0.001). Presepsin AUC for the differential diagnosis of sepsis and non–communicable CVD was 0.87 (95% CI: 0.81–0.93), PCT – 0.84 (95% CI: 0.77–0.90), CRP – 0.72 (95% CI: 0.64–0.80). The combination of presepsin and PCT increased the AUC to 0.91. With a presepsin threshold value of 582 pg/ml, the sensitivity reached 85.7%, and the specificity was 79.5%.

Conclusion. Presepsin demonstrates high diagnostic accuracy in early detection of sepsis, comparable to or exceeding that of PCT and significantly superior to CRP. The combination of presepsin and PCT optimizes the differential diagnosis of infectious and non-infectious inflammations in ICU patients.

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