Comparing dynamic presepsin and procalcitonin measurements in septic adults: development and testing of a mortality risk in sepsis summation score.

Abstract

Background & Objective: Though numerous biomarkers have been identified with diagnostic and/or prognostic value in sepsis patients; few are sensitive early enough to guide early decision-making. Presepsin (PSEP) appears to spike within the first few days of systemic bacterial infection. We evaluated PSEP’s sensitivity, specificity, accuracy, and area-under-the-curve (AUC) predicting sepsis-related mortality, both used alone and combined with other parameters.

Methodology: A prospective study was conducted of N = 84 adult sepsis patients admitted to critical care units (CCU) at a single, university-affiliated tertiary hospital. All were followed until either death or 90 days after CCU admission, with biomarkers including PSEP and procalcitonin (PCT) measured on days 1, 3, 5, 7 and 12. Bivariable analysis was conducted to identify potential predictors of mortality for use in multivariable analysis and ultimate evaluation of a mortality risk in sepsis summation score.

Results: Among 84 patients, 44 died, 12 remained hospitalized, and 28 were discharged home. At all five blood draws, PSEP levels were significantly higher in sepsis non-survivors than survivors, versus no instances with PCT. Multivariable analysis identified three statistically significant predictors of mortality: patient age, baseline SOFA score, and the average of patients’ day 1 and 3 PSEP levels. From these three variables, all attained within the first 72 hours of CCU admission, a 9-point scale was constructed that was 83.8% sensitive, 71.1% specific, and 77.3% accurate predicting ultimate sepsis-related mortality (AUC = 0.80).

Conclusions: Alone and combined with patient age and baseline SOFA score, early PSEP levels are highly sensitive and specific predicting sepsis-related mortality.

Keywords: Presepsin; Procalcitonin; Predictors; Mortality; Sepsis; SOFA

Citation: Algethamy HM, Aboudeif MM, Ali MAM, Amin AM, Amin SN. Comparing dynamic presepsin and procalcitonin measurements in septic adults: development and testing of a mortality risk in sepsis summation score. Anaesth. pain intensive care 2026;30(2):248-261. DOI: 10.35975/apic.v30i2.3134

Received: August 28, 2025; Revised: December 26, 2025; Accepted: January 01, 2026