Pancreatic Stone Protein as an Emerging Biomarker in Paediatric Nosocomial and Postoperative Sepsis: An Integrative Review of Diagnostic and Prognostic Performance

Healthcare-associated infections remain a major cause of morbidity and mortality in paediatric patients, particularly among those undergoing surgery or requiring intensive care. Distinguishing postoperative sterile inflammation from early sepsis is clinically challenging because conventional biomarkers such as C-reactive protein (CRP) and procalcitonin lack sufficient specificity. This narrative review aimed to analyse current evidence on pancreatic stone protein (PSP) as an emerging biomarker for the detection and risk stratification of infection in paediatric populations. A structured literature search was performed in PubMed and Web of Science for studies published between 2020 and 2026 using terms related to nosocomial infections, paediatric surgery, and PSP, identifying 147 articles; 54 met the inclusion criteria after screening. The analysed studies show that PSP levels increase significantly in children with sepsis compared with those with non-infectious systemic inflammation and are associated with bacteraemia, organ dysfunction, and mortality. In several paediatric cohorts, PSP demonstrated diagnostic performance comparable to or better than traditional markers, with reported AUROC values up to approximately 0.82 for distinguishing sepsis from non-infectious inflammation. Evidence from neonatal and high-risk populations also suggests strong sensitivity and specificity for early infection detection. Overall, PSP appears to be a promising biomarker for the early identification and prognostic stratification of paediatric sepsis; however, variability among studies highlights the need for larger multicentre prospective investigations and for integrating PSP into multimarker diagnostic algorithms.