Diagnostic performance of procalcitonin and presepsin in sepsis: a systematic review and meta-analysis

Sepsis is a critical emergency condition characterized by life-threatening organ dysfunction due to a dysregulated response to infection. In the fast-paced emergency department (ED) setting, rapid identification and prompt initiation of treatment within the initial hours following sepsis onset are critical for reducing mortality and improving patient outcomes. However, a timely and accurate diagnosis remains a significant challenge in emergency medicine. Biomarkers such as procalcitonin (PCT) and presepsin (P-SEP) have been proposed as tools to distinguish sepsis from other non-infectious inflammatory conditions frequently encountered in the ED, though their diagnostic effectiveness remains controversial. This study aimed to evaluate the diagnostic performance of PCT and P-SEP for diagnosis patients with sepsis.

A comprehensive systematic search was conducted across the Cochrane Central Register of Controlled Trials, PubMed, and Scopus databases up to April 1st, 2024 and updated on June 30th, 2025. Studies reporting sensitivity and specificity of PCT and P-SEP for sepsis detection among patients in acute and emergency settings were included. Hierarchical modeling techniques were utilized to pool data for sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) along with their 95% confidence intervals (CIs).

Thirty-eight observational studies met inclusion criteria. The pooled sensitivities and specificities for detecting sepsis using PCT were 0.78 (95% CI: 0.74-0.81) and 0.77 (95% CI: 0.71-0.82), respectively. Similarly, for P-SEP, pooled sensitivity and specificity were 0.82 (95% CI: 0.77-0.86) and 0.78 (95% CI: 0.73-0.83), respectively. No statistically significant differences were identified between PCT and P-SEP regarding sensitivity (p = 0.169) or specificity (p = 0.792). The summary receiver operating characteristic analysis yielded an AUROC of 0.84 (95% CI: 0.81-0.87) for PCT and 0.87 (95% CI: 0.84-0.90) for P-SEP.

Both PCT and P-SEP represent reliable biomarkers for early and accurate sepsis detection in acute and ED settings, demonstrating comparable diagnostic performance. Their integration into routine ED assessment protocols may support timely clinical decision-making and prompt initiation of appropriate treatment strategies.