LABORATORY EVALUATION OF PRESEPSIN AND PROCALCITONIN VERSUS C-REACTIVE PROTEIN AND WHITE BLOOD CELLS FOR SEPSIS DIAGNOSIS IN ADULTS

Abstract Background: Early and accurate discrimination of sepsis from non-infectious systemic inflammation is essential to guide antimicrobials and improve outcomes. Novel biomarkers presepsin (sCD14-ST) and procalcitonin (PCT) may outperform traditional markers (C-reactive protein [CRP], white blood cell count [WBC]). Methods: Following PRISMA principles, we synthesized eight investigator-provided original studies evaluating diagnostic performance of presepsin and/or PCT against CRP/WBC in adults with suspected infection across emergency and intensive-care settings (n=1,180 patients/samples). Primary outcomes were area under the ROC curve (AUC), sensitivity and specificity. Risk of bias was appraised qualitatively. Narrative synthesis was chosen due to between-study heterogeneity (assay platforms, thresholds, reference standards). Results: Presepsin showed high diagnostic accuracy in multiple cohorts: AUC 0.908 with sensitivity 87.8% and specificity 81.4% at 600 pg/mL; AUC 0.709 under Sepsis-3 in ED and differentiated septic shock from sepsis, correlating with SOFA. PCT generally exceeded CRP; in one ICU cohort, PCT AUC 0.776–0.816 depending on cut-off, while presepsin AUC 0.734. In severe sepsis/septic shock, presepsin AUCs 0.72–0.84 and prognostic value for mortality. Conclusion: Across heterogeneous adult populations, presepsin and PCT consistently outperform CRP/WBC for diagnosing sepsis, with presepsin offering additional severity/prognostic insights. Evidence supports using these biomarkers alongside clinical scores and cultures rather than in isolation.