{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T23:05:50Z","timestamp":1793747150443,"version":"4.6.1"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Presepsin, an innate immune activation biomarker, shows potential for predicting the prognosis of sepsis, but its predictive accuracy remains unclear. This meta-analysis aims to evaluate its efficiency for predicting the risk of mortality in sepsis and septic shock.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Per PRISMA guidelines, four databases were searched until January 2025. Sixteen observational studies with 2,066 patients were included. Pooled sensitivity, specificity, DOR, and AUC were calculated using bivariate random-effects models. The sources of heterogeneity were explored via subgroup analyses and meta-regression. Study quality was assessed with QUADAS-2.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Presepsin showed moderate accuracy for predicting the risk of mortality (pooled AUC 0.80, 95% CI: 0.76-0.83). The pooled sensitivity and specificity were 76% (95% CI: 69-82%) and 70% (95% CI: 59-78%), respectively. Sensitivity was notably higher in patients with septic shock (90%) compared to those with sepsis (75%), whereas specificity was comparatively lower (50% vs. 77%). Substantial heterogeneity stemmed from threshold variability and geographic differences (particularly in Korean cohorts). Prospective studies had higher sensitivity (80%) than retrospective studies (60%). No publication bias was detected.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Presepsin is a pragmatic biomarker for predicting the risk of mortality, with enhanced sensitivity in septic shock. Presepsin may be integrated into clinical decision-making for early intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Systematic Review Registration<\/jats:title><jats:p>\nPROSPERO, identifier CRD42025639268.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2025.1680877","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T05:43:20Z","timestamp":1760507000000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Prognostic value of presepsin in sepsis and septic shock: a 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