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Presepsin and Procalcitonin as Potential Biomarkers for Early Diagnosis and Prognosis of Sepsis in Critically Ill Patients

Background: Sepsis has a poor prognosis for critically ill patients, even with intensive management. Early diagnosis of sepsis and 
detection of patients with worsening prognosis are important for 
immediate intervention to improve the clinical outcome. Objective: To 
investigate serum presepsin (PS) and procalcitonin (PCT) as early diagnostic 
and prognostic biomarkers for sepsis in critically ill patients. Methods: 60 critically ill patients with sepsis were subdivided into three groups of 
sepsis, severe sepsis and septic shock according 
to Acute Physiology and Chronic Health Evaluation II (APACHEII) and quick Sequential Organ Failure Assessment 
(qSOFA) scores. Patients were compared with 20 age and sex matched 
controls. Serum PS and PCT were measured by enzyme linked immunosorbent assay 
(ELISA). Results: Serum PS and PCT levels were significantly increased 
in septic patients than controls, and their increase was positively correlated 
with progression of sepsis severity till reached the highest levels in septic 
shock. Receiver operating characteristic 
(ROC) curve for predicting sepsis revealed that PS has the highest area 
under curve (AUC) (0.967) with 97.5% sensitivity, 85% specificity and cut-off 
of >635.5 pg/mL, 
followed by PCT that has AUC (0.946), 97.5% sensitivity, 95% specificity and 
cut-off of >319.7 pg/mL. 
C-reactive protein (CRP) showed the lowest AUC (0.902) with 75% sensitivity, 
100% specificity and cut-off of >7 mg/L. ROC curve for predicting septic 
shock showed that PS has the highest AUC (0.969) with 90% sensitivity, 97.5% 
specificity and cut-off of >5500.6 pg/mL, followed by CRP that has AUC 
(0.945), 90% sensitivity, 87.5% specificity and cut-off of >63 mg/L. PCT 
showed the lowest AUC (0.889) with 90% sensitivity, 97.5% specificity and 
cut-off of >822.1 pg/mL. Conclusions: Serum PS and PCT were promising 
biomarkers for early diagnosis and prognosis of sepsis in critically ill 
patients, but PS was superior to PCT.