# Prognostic value of presepsin in sepsis and septic shock: a meta-analysis

## TL;DR

This study finds that presepsin can help predict mortality in sepsis and septic shock, with better accuracy in the latter.

## Contribution

The study provides a meta-analysis of presepsin's prognostic accuracy in sepsis and septic shock.

## Key findings

- Presepsin has moderate accuracy for predicting mortality (AUC 0.80).
- Sensitivity is higher in septic shock (90%) than in sepsis (75%).
- Heterogeneity is linked to threshold variability and geographic differences.

## Abstract

Presepsin, an innate immune activation biomarker, shows potential for predicting the prognosis of sepsis, but its predictive accuracy remains unclear. This meta-analysis aims to evaluate its efficiency for predicting the risk of mortality in sepsis and septic shock.

Per PRISMA guidelines, four databases were searched until January 2025. Sixteen observational studies with 2,066 patients were included. Pooled sensitivity, specificity, DOR, and AUC were calculated using bivariate random-effects models. The sources of heterogeneity were explored via subgroup analyses and meta-regression. Study quality was assessed with QUADAS-2.

Presepsin showed moderate accuracy for predicting the risk of mortality (pooled AUC 0.80, 95% CI: 0.76-0.83). The pooled sensitivity and specificity were 76% (95% CI: 69-82%) and 70% (95% CI: 59-78%), respectively. Sensitivity was notably higher in patients with septic shock (90%) compared to those with sepsis (75%), whereas specificity was comparatively lower (50% vs. 77%). Substantial heterogeneity stemmed from threshold variability and geographic differences (particularly in Korean cohorts). Prospective studies had higher sensitivity (80%) than retrospective studies (60%). No publication bias was detected.

Presepsin is a pragmatic biomarker for predicting the risk of mortality, with enhanced sensitivity in septic shock. Presepsin may be integrated into clinical decision-making for early intervention.

PROSPERO, identifier CRD42025639268.