Presepsin (sCD14-ST), an innate immune response marker in sepsis

Innate immunity is the first barrier to fight off bacteria, and partly relies on the engagement of the membrane coreceptor CD14. A product of cleavage of CD14, the soluble subtype of CD14 (sCD14-ST) or presepsin, is released in circulation after activation of defense mechanisms. Presepsin can be detected by biochemical methods and therefore appears as an emergent biomarker of infection. Here we present the rationale for presepsin development and recent data supporting its use at bedside. Presepsin may be worthwhile for early diagnosis and prognostic assessment of patients with systemic infections. This biomarker shows high specificity, and results from experimental and clinical studies are reinforcing the proof of concept. Performances place presepsin at the level of PCT who is used as a comparator. Biomarkers of infection are futile to diagnose infection with direct access to bacteria (as urinary tract infection, meningitis), but their use can be advocated to ascertain unclear diagnosis. Future developments of presepsin will probably use clinical models with a Bayesian approach to ascertain the additional value of the biomarker at bedside.