What is Presepsin?
Presepsin (soluble CD14-subtype, sCD14-ST) is a glycoprotein biomarker that increases in response to bacterial infection and serves as a diagnostic and prognostic tool for sepsis, cleaved from CD14 receptors on monocytes and macrophages during the inflammatory response to infection. 1, 2
Biological Mechanism
Presepsin originates from CD14, a co-receptor expressed on monocyte and macrophage membranes that recognizes lipopolysaccharide-lipopolysaccharide binding protein complexes from bacterial cell walls 3
During infection, CD14 is enzymatically cleaved, releasing the soluble fragment presepsin into plasma as part of the inflammatory cascade activation 3
The cleavage and release occur specifically in response to microbial infection, making presepsin more specific for bacterial sepsis than general inflammatory markers 4
Clinical Utility in Sepsis Diagnosis
Presepsin demonstrates higher sensitivity and specificity for sepsis diagnosis compared to traditional biomarkers like C-reactive protein (CRP) and comparable or superior performance to procalcitonin (PCT) 1, 4
In one Korean study, presepsin showed significantly higher values in infected versus non-infected patients (1403.47 pg/mL vs 239.00 pg/mL), with higher area under the ROC curve than other conventional biomarkers 1
Presepsin levels decrease significantly during effective treatment, making it useful for monitoring therapeutic response 1
However, some studies show conflicting results: one emergency department study found PCT had superior diagnostic accuracy (ROC AUC 0.910 for infection) compared to presepsin (ROC AUC 0.775 for sepsis), suggesting presepsin may not always outperform PCT 5
Prognostic Value
Presepsin can assess sepsis severity and predict prognosis, though one study found it did not correlate significantly with APACHE III scores or 30-day mortality 1, 2
The biomarker is useful for prognostic stratification when combined with clinical rating scores and other established biomarkers rather than used in isolation 2
Clinical Context and Limitations
Presepsin emerged as a sepsis biomarker in 2004 and has been studied primarily over the last decade, with no publications identified before 2010 2, 4
Most evidence supports presepsin as a supplemental diagnostic tool rather than a standalone test, best used in conjunction with PCT, CRP, and clinical assessment 2, 4
The lack of multicenter studies limits definitive conclusions about optimal cutoff values and clinical implementation strategies 4
Presepsin appears most valuable for early diagnosis in emergency and critical care settings, where rapid differentiation between infectious and non-infectious causes of systemic inflammatory response syndrome is crucial 2, 3