Prognostic Role of Presepsin, Proadrenomedullin, and Interleukin-6 in Sepsis

This study aimed to evaluate the predictive value of serum presepsin, proadrenomedullin, and interleukin-6 levels for prognosis and mortality in patients diagnosed as having sepsis in the emergency department.

This prospective observational cohort study was conducted with patients diagnosed as having sepsis in the emergency department of a tertiary university hospital. The study analyzed the patients' demographic characteristics, comorbidities, source of sepsis, biomarker levels, treatments, microbial culture results, and 30-day mortality. Blood samples were collected upon the patients' admission to the emergency department.

Patients with septic shock had significantly higher serum interleukin-6 levels (363.2 pg/mL) than those with sepsis (140.6 pg/mL; P = .003). In contrast, proadrenomedullin levels were significantly lower in patients with septic shock (0.27 pmol/mL) than those with sepsis (0.48 pmol/mL; P = .02). Although presepsin levels were higher in the septic shock group (178.3 ng/L vs 156.9 ng/L), this difference was not statistically significant (P = .81). However, in multivariable analysis, none of the biomarkers remained independent predictors after adjustment for clinical confounders. Interleukin-6 levels were also significantly higher in nonsurvivors than survivors (363.2 pg/mL vs 195.5 pg/mL; P = .046). In receiver operating characteristic analysis, interleukin-6 (area under the curve, 0.701), proadrenomedullin (area under the curve, 0.658), and procalcitonin (area under the curve, 0.625) demonstrated moderate predictive ability for septic shock.

Interleukin-6, presepsin, and proadrenomedullin may provide supportive diagnostic and prognostic information in patients with sepsis and septic shock in the emergency department. However, none of these biomarkers remained independent prognostic predictors after adjustment for clinical confounders. Further studies are needed to better clarify their clinical utility and prognostic role.