{
  "abstract": "Objectives To evaluate the diagnostic accuracy of presepsin and procalcitonin (PCT) for sepsis and septic shock (Sepsis-3) in the emergency department (ED) based on the Sepsis-3 definition, where early diagnosis remains challenging due to the lack of rapid and reliable diagnostic methods.Methods This multicentre prospective cohort study recruited adults from eight EDs in Thailand between October 2020 and June 2022. Patients with suspected infection or those who met the quick Sequential Organ Failure Assessment criteria were enrolled. Admission blood samples were analysed for presepsin, PCT, lactate and blood culture, with follow-up presepsin and PCT measurements performed on days 3 and 7, and follow-up for 30-day mortality. Sepsis diagnosis was adjudicated with reference to the Sepsis-3 criteria and blood culture result. Diagnostic accuracy metrics, including the area under the receiver operating characteristics curve (AUROCs), sensitivity, specificity and predictive values of presepsin and PCT were evaluated.Results Of 668 included participants, 438 (65.6%) were diagnosed with sepsis and 58 (8.7%) with septic shock. Presepsin levels were significantly higher in patients with Sepsis-3 than in patients without sepsis at ED admission and decreased over time. Presepsin exhibited a slightly higher AUROC for predicting sepsis (AUROC 0.63 (95% CI 0.59 to 0.67)) and septic shock (AUROC 0.73 (95% CI 0.66 to 0.80)) compared with PCT (AUROC for sepsis 0.62, 95% CI 0.58 to 0.66 and septic shock 0.72, 95% CI 0.65 to 0.78). Elevated presepsin and PCT levels were associated with increased mortality within 30 days (OR 2.61, 95% CI 1.73 to 3.92 and OR of 1.62, 95% CI 1.09 to 2.42 consequently).Conclusions Presepsin showed slightly higher diagnostic accuracy than PCT, but overall diagnostic accuracy was modest. When interpreted together with clinical assessment and routine tests, presepsin may assist early risk stratification and support, rather than replace, clinical judgement in decisions such as resuscitation or antibiotic initiation.",
  "authors": [
    {
      "affiliations": [
        "Department of Emergency Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand",
        "Thai College of Emergency Physicians, Bangkok, Thailand"
      ],
      "name": "Jiraporn Sri-on"
    },
    {
      "affiliations": [
        "Thai College of Emergency Physicians, Bangkok, Thailand",
        "Department of Emergency Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand"
      ],
      "name": "Kiattichai Daorattanachai"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand"
      ],
      "name": "Kittiyaporn Wiwatcharagoses"
    },
    {
      "affiliations": [
        "Thai College of Emergency Physicians, Bangkok, Thailand",
        "Department of Emergency Medicine, Khon Kaen University, Khon Kaen, Thailand"
      ],
      "name": "Pariwat Phungoen"
    },
    {
      "affiliations": [
        "Faculty of Medicine, King Mongkut’s Institute of Technology Ladkrabang Lat Krabang, Bangkok, Thailand",
        "Division of Nephrology, Department of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand"
      ],
      "name": "Suramath Isaranuwatchai"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand"
      ],
      "name": "Pitsucha Sanguanwit"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Faculty of medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand"
      ],
      "name": "Thammapad Piyasuwankul"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand"
      ],
      "name": "Wisarut Bunchit"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand"
      ],
      "name": "Natchapon Sinsuwan"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand"
      ],
      "name": "Rapeeporn Rojsaengroeng"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Khon Kaen University, Khon Kaen, Thailand"
      ],
      "name": "Korakot Apiratwarakul"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Khon Kaen University, Khon Kaen, Thailand"
      ],
      "name": "Nipa Udonjarut"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand"
      ],
      "name": "Parima Voharnsuchon"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand"
      ],
      "name": "Chuenruthai Angkoontassaneeyarat"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Faculty of medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand"
      ],
      "name": "Premruedee Dansuebsakun"
    },
    {
      "affiliations": [
        "Thai College of Emergency Physicians, Bangkok, Thailand",
        "Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand",
        "Strategy to Achieve Emergency Medicine Research Network in Thailand (START) Working Group, Chiang Mai, Thailand",
        "Acute Care and Emergency Medicine Research Cluster, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand"
      ],
      "name": "Borwon Wittayachamnankul"
    }
  ],
  "title": "Presepsin for sepsis diagnosis in emergency departments: a multicentre study",
  "uid": "f0eeb4bb-30b1-53e6-a4a4-6b9b42e7a87a"
}