Diagnostic and Prognostic Evaluation of Presepsin Levels in Neonatal Septicemia: A Hospital-Based Study

Neonatal septicemia is a life-threatening condition with high mortality, and its early diagnosis remains a major challenge. Rapid and reliable biomarkers are essential for timely management. Presepsin, a soluble CD14 subtype, has emerged as a promising early sepsis marker, though evidence in neonates is scarce. This study evaluated its diagnostic and prognostic performance in suspected neonatal sepsis, covering bacterial and fungal infections.

An analytical cross-sectional study was conducted in the NICU of a tertiary hospital from May 2023 to November 2024. Eighty-eight neonates with clinically suspected sepsis were enrolled. Blood samples were collected for culture, C-reactive protein (CRP) measured by semiquantitative latex agglutination and Presepsin measured by ELISA. Diagnostic performance was assessed via receiver operating characteristic analysis, and associations with clinical features, birth weight, and outcomes were evaluated.

Blood cultures were positive in 57 (64.8%) neonates, including 39 bacterial and 18 fungal cases. Presepsin levels were significantly higher in culture-proven sepsis (1208.5 ± 319.4 pg/mL) than probable sepsis (828.9 ± 235.5 pg/mL, p < 0.001). ROC analysis identified a cutoff of 906.6 pg/mL, yielding 90% sensitivity, 88% specificity, and 84% diagnostic accuracy. Presepsin levels rose faster than CRP, enabling earlier detection. Higher levels were noted in fungal sepsis (1441.4 ± 357.5 pg/mL) and in neonates with poor outcomes, correlating with longer hospital stays.

Presepsin is a rapid, reliable biomarker for early diagnosis and prognosis of neonatal sepsis, including fungal infections. Its use alongside clinical assessment can support timely therapeutic decisions, reduce hospital stay, and improve survival in high-risk neonates.