Presepsin as a Prognostic Biomarker for Short-Term Mortality in Adult Patients With Sepsis: A Systematic Review

Sepsis is a life-threatening medical condition that continues to be a significant global health concern. It is well recognised as a leading cause of morbidity and mortality among hospitalised and critically ill patients of all age groups. Several clinical severity scores, such as the Sequential Organ Failure Assessment (SOFA) and the Acute Physiology and Chronic Health Evaluation II (APACHE), are commonly used to identify and categorise sepsis. However, such clinical tools often require multiple physiological parameters and may not always provide rapid prognostic information. Similarly, inflammatory biomarkers such as C-reactive protein and procalcitonin exhibit variable prognostic value when used alone. Presepsin, a soluble CD14 subtype released when macrophages and monocytes are activated as part of the human innate immune response to infection, has emerged as a promising biomarker to predict infection severity and adverse outcomes in sepsis. This systematic review was conducted to evaluate whether presepsin could serve as a reliable marker to predict short-term (28-day or 30-day) mortality among adult patients with sepsis. A detailed literature search and screening were conducted using PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020) guidelines across multiple electronic databases, including PubMed, ScienceDirect, Cochrane Library, and Embase. Following the screening process, a total of 19 observational studies and one systematic review were ultimately selected for the final analysis. Presepsin levels were generally higher in patients with greater disease severity and frequently higher in non-survivors. Although presepsin demonstrated moderate prognostic performance, established clinical severity scores often outperformed presepsin. Overall, existing evidence suggests that presepsin may provide additional prognostic value when integrated with established clinical scoring tools.