A NEW retrospective study suggests that plasma presepsin may be a more reliable predictor of short-term mortality than conventional infection biomarkers in patients with urinary tract infection (UTI)–related severe infection presenting to the emergency department.
The single-centre study evaluated 69 adult patients admitted with UTI-related severe infection between May 2022 and August 2023. Researchers aimed to assess whether presepsin, a biomarker released during bacterial phagocytosis, could outperform established inflammatory markers such as procalcitonin (PCT), C-reactive protein (CRP), and white blood cell (WBC) count in predicting 28-day mortality.
Clinical data collected at admission included vital signs and laboratory parameters, with mortality at 28 days used as the primary outcome. To minimise confounding, survivors and non-survivors were additionally matched using propensity scores in a 2:1 ratio based on age, sex, and estimated glomerular filtration rate.
Presepsin Outperforms Conventional Biomarkers
In the overall cohort, presepsin demonstrated the strongest predictive performance for 28-day mortality, with an area under the receiver operating characteristic curve (AUROC) of 0.716. This exceeded the predictive ability of PCT (AUROC 0.641), CRP (0.488), and WBC count (0.433). Multivariable analysis showed that higher presepsin levels were independently associated with an increased risk of mortality (hazard ratio 1.026; p=0.008).
These findings were consistent in the propensity-matched analysis. Within this cohort, presepsin again achieved the highest AUROC (0.660), compared with PCT (0.584), CRP (0.496), and WBC count (0.436), reinforcing its relative prognostic value.
The authors note that traditional biomarkers often show limited specificity in UTI-related severe infection, particularly in older patients or those with renal impairment. Presepsin, which reflects activation of the innate immune response, may therefore offer improved risk stratification in the emergency setting.
Study Limitations and Need for Validation
While the study is limited by its retrospective design, small sample size, and single-centre scope, the results suggest that presepsin could be a useful adjunct for early identification of high-risk patients with severe UTI. The authors highlight the need for larger, prospective multicentre studies to validate these findings and to determine how presepsin might be incorporated into routine clinical decision-making.
Reference
Lee JW et al. Plasma presepsin as a predictor of mortality in patients with UTI-related severe infection: a single-center retrospective study. BMC Urol. 2025;25:314.
