Article Data

  • Views 836
  • Dowloads 163

Original Research

Open Access

Presepsin as a predictor of septic shock and mortality in patients with urinary tract infection according to the Sepsis-3 definitions

  • Gi Bi Yang1
  • Kyeong Ryong Lee2
  • Dae Young Hong2
  • Sang O Park2
  • Jong Won Kim2
  • Sin Young Kim1
  • Young Hwan Lee2,*,

1Department of Emergency Medicine, Konkuk University Medical Center, 05030 Seoul, Republic of Korea

2Department of Emergency Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, 05030 Seoul, Republic of Korea

DOI: 10.22514/sv.2024.018 Vol.20,Issue 2,February 2024 pp.70-77

Submitted: 26 July 2023 Accepted: 29 August 2023

Published: 08 February 2024

*Corresponding Author(s): Young Hwan Lee E-mail:


The objective of this study was to investigate whether presepsin can serve as a useful biomarker for predicting septic shock and mortality rates in patients with urinary tract infections (UTI) as defined by the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). This single-center and prospective observational study was carried out between December 2019 and December 2022 and included 171 UTI patients divided into two groups: a non-septic shock group (n = 121) and a septic shock group (n = 50). The primary outcome of this study was the development of septic shock; the secondary outcome was 30-day hospital mortality. Receiver operating characteristic (ROC) curves and multivariate regression analyses were performed to investigate the predictive value of presepsin levels for septic shock and the Cox proportional hazards model was used to determine the risk factors for 30-day hospital mortality in UTI patients. Septic shock patients had significantly higher serum levels of presepsin when compared to the non-septic shock group (p < 0.001). In multivariate logistic regression analysis, presepsin demonstrated its independent role as a risk factor for septic shock (odds ratio (OR): 1.002; 95% confidence interval (CI): 1.001–1.002; p < 0.001). The multivariate Cox proportional hazards model indicated that presepsin represents a significant predictor of 30-day hospital mortality in septic shock patients (hazard ratio (HR): 1.0005; 95% CI: 1.0001–1.001; p < 0.05). The ROC curve for diagnosing septic shock had an area under the curve (AUC) of 0.739 with a cutoff value of 447 pg/mL for presepsin. For the prediction of 30-day hospital mortality in patients with UTI, an optimal presepsin cutoff of 709 pg/mL was determined; ROC curve analysis yielded an AUC of 0.744. When applying the Sepsis-3 criteria, presepsin levels represented a significant independent risk factor for septic shock and 30-day hospital mortality in UTI patients.


Presepsin; Septic shock; Urinary tract infection; Emergency department

Cite and Share

Gi Bi Yang,Kyeong Ryong Lee,Dae Young Hong,Sang O Park,Jong Won Kim,Sin Young Kim,Young Hwan Lee. Presepsin as a predictor of septic shock and mortality in patients with urinary tract infection according to the Sepsis-3 definitions. Signa Vitae. 2024. 20(2);70-77.


[1] Sekine Y, Kotani K, Oka D, Nakayama H, Miyazawa Y, Syuto T, et al. Presepsin as a predictor of septic shock in patients with urinary tract infection. BMC Urology. 2021; 21: 144.

[2] Zhang L, Zhang F, Xu F, Wang Z, Ren Y, Han D, et al. Construction and evaluation of a sepsis risk prediction model for urinary tract infection. Frontiers in Medicine. 2021; 8: 671184.

[3] Contenti J, Occelli C, Lemoel F, Ferrari P, Levraut J. Presepsin versus other biomarkers to predict sepsis and septic shock in patients with infection defined by Sepsis-3 criteria: the PREDI study of diagnostic accuracy. Emergencias. 2019; 31: 311–317.

[4] Vincent J, Bakker J. Blood lactate levels in sepsis: in 8 questions. Current Opinion in Critical Care. 2021; 27: 298–302.

[5] Weinberger J, Klompas M, Rhee C. What is the utility of measuring lactate levels in patients with sepsis and septic shock? Seminars in Respiratory and Critical Care Medicine. 2021; 42: 650–661.

[6] Claessens Y, Trabattoni E, Grabar S, Quinquis L, Der Sahakian G, Anselmo M, et al. Plasmatic presepsin (sCD14-ST) concentrations in acute pyelonephritis in adult patients. Clinica Chimica Acta. 2017; 464: 182–188.

[7] Kondo Y, Umemura Y, Hayashida K, Hara Y, Aihara M, Yamakawa K. Diagnostic value of procalcitonin and presepsin for sepsis in critically ill adult patients: a systematic review and meta-analysis. Journal of Intensive Care. 2019; 7: 22.

[8] Piccioni A, Santoro MC, de Cunzo T, Tullo G, Cicchinelli S, Saviano A, et al. Presepsin as early marker of sepsis in emergency department: a narrative review. Medicina. 2021; 57: 770.

[9] Yamamoto T, Nishimura T, Kaga S, Uchida K, Tachibana Y, Esaki M, et al. Diagnostic accuracy of presepsin for sepsis by the new Sepsis-3 definitions. The American Journal of Emergency Medicine. 2019; 37: 1936–1941.

[10] Kahveci U, Ozkan S, Melekoglu A, Usul E, Ozturk G, Cetin E, et al. The role of plasma presepsin levels in determining the incidence of septic shock and mortality in patients with sepsis. Journal of Infection in Developing Countries. 2021; 15: 123–130.

[11] Kweon OJ, Choi J, Park SK, Park AJ. Usefulness of presepsin (sCD14 subtype) measurements as a new marker for the diagnosis and prediction of disease severity of sepsis in the Korean population. Journal of Critical Care. 2014; 29: 965–970.

[12] Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Critical Care Medicine. 2001; 29: 1303–1310.

[13] Levy MM, Artigas A, Phillips GS, Rhodes A, Beale R, Osborn T, et al. Outcomes of the surviving sepsis campaign in intensive care units in the USA and Europe: a prospective cohort study. The Lancet Infectious Diseases. 2012; 12: 919–924.

[14] Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016; 315: 801–810.

[15] Kaur R, Kaur R. Symptoms, risk factors, diagnosis and treatment of urinary tract infections. Postgraduate Medical Journal. 2021; 97: 803–812.

[16] Yang SS, Tsai J, Kanematsu A, Han C. Asian guidelines for urinary tract infection in children. Journal of Infection and Chemotherapy. 2021; 27: 1543–1554.

[17] Guliciuc M, Maier AC, Maier IM, Kraft A, Cucuruzac RR, Marinescu M, et al. The urosepsis—a literature review. Medicina. 2021; 57: 872.

[18] Brun-Buisson C. The epidemiology of the systemic inflammatory response. Intensive Care Medicine. 2000; 26: S064–S074.

[19] Bisarya R, Song X, Salle J, Liu M, Patel A, Simpson SQ. Antibiotic timing and progression to septic shock among patients in the ED with suspected infection. Chest. 2022; 161: 112–120.

[20] Gander RM, Byrd L, DeCrescenzo M, Hirany S, Bowen M, Baughman J. Impact of blood cultures drawn by phlebotomy on contamination rates and health care costs in a hospital emergency department. Journal of Clinical Microbiology. 2009; 47: 1021–1024.

[21] Velissaris D, Zareifopoulos N, Karamouzos V, Karanikolas E, Pierrakos C, Koniari I, et al. presepsin as a diagnostic and prognostic biomarker in sepsis. Cureus. 2021; 13: e15019.

[22] Lelubre C, Anselin S, Zouaoui Boudjeltia K, Biston P, Piagnerelli M. Interpretation of c-reactive protein concentrations in critically ill patients. BioMed Research International. 2013; 2013: 1–11.

[23] Maruna P, Nedelníková K, Gürlich R. Physiology and genetics of procalcitonin. Physiological Research. 2000; 49: S57–S61.

[24] Singh K, Singh S, Kumar P, Khera D, Sharma P, Toteja N, et al. Is there a role of presepsin as a novel biomarker in pediatric sepsis? Indian Journal of Critical Care Medicine. 2022; 26: 712–716.

[25] Ulla M, Pizzolato E, Lucchiari M, Loiacono M, Soardo F, Forno D, et al. Diagnostic and prognostic value of presepsin in the management of sepsis in the emergency department: a multicenter prospective study. Critical Care. 2013; 17: R168.

[26] Pizzolato E, Ulla M, Galluzzo C, Lucchiari M, Manetta T, Lupia E, et al. Role of presepsin for the evaluation of sepsis in the emergency department. Clinical Chemistry and Laboratory Medicine. 2014; 52: 1395–1400.

[27] Baik SM, Park J, Kim TY, Choi SH, Hong KS. Validation of presepsin measurement for mortality prediction of sepsis: a preliminary study. Acute and Critical Care. 2022; 37: 527–532.

[28] Arakawa K, Saeki A, Ide R, Matsushita Y. Presepsin cut-off value for diagnosis of sepsis in patients with renal dysfunction. PLOS ONE. 2022; 17: e0273930.

[29] Tsuchida T, Ie K, Okuse C, Hirose M, Nishisako H, Torikai K, et al. Determining the factors affecting serum presepsin level and its diagnostic utility: a cross-sectional study. Journal of Infection and Chemotherapy. 2021; 27: 585–591.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time