{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T09:05:44Z","timestamp":1790759144298,"version":"4.1.0"},"reference-count":28,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Biochemical markers used in the diagnostic evaluation of pleural effusions are limited in both number and diagnostic accuracy. Presepsin has shown promise in bacterial infections. This study aimed to evaluate the diagnostic utility of pleural fluid presepsin for differentiating transudative from exudative pleural effusions. Methods: In this prospective observational study, presepsin concentrations were measured in pleural fluid obtained during diagnostic thoracentesis. Patients were classified according to Light\u2019s criteria and final clinical diagnosis. Receiver operating characteristic (ROC) analysis was performed to assess diagnostic performance, while multivariable logistic regression identified independent predictors of exudative pleural effusions. Associations between presepsin concentrations and mortality, infectious etiology, and pleural fluid culture positivity were also analyzed. Results: Eighty-eight patients were included, comprising 48 (54.5%) exudative and 40 (45.5%) transudative pleural effusions. Median pleural fluid presepsin concentrations were significantly higher in transudative than in exudative effusions (410.79 vs. 368.64 pg\/mL, p = 0.010). A conventional model based on routinely available clinical and laboratory variables yielded an AUC of 0.797, which increased to 0.807 after adding pleural fluid presepsin (\u0394AUC = 0.010; DeLong p = 0.606). Pleural fluid presepsin showed limited discrimination for infectious effusions (AUC = 0.618) and provided no significant incremental diagnostic value beyond routine biomarkers. Conclusions: Pleural fluid presepsin showed limited diagnostic performance and did not provide incremental diagnostic information beyond routinely available biomarkers for either transudative\u2013exudative or infectious\u2013noninfectious classification. The unexpectedly higher concentrations in transudative effusions remain observational and cannot be attributed to a specific biological mechanism.<\/jats:p>","DOI":"10.3390\/diagnostics16193122","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T16:31:14Z","timestamp":1790353874000},"page":"3122","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Is Pleural Fluid Presepsin a Reliable Diagnostic Biomarker for Pleural Effusions?"],"prefix":"10.3390","volume":"16","author":[{"given":"Nihal","family":"Ert\u00fcrk","sequence":"first","affiliation":[{"name":"Emergency Department, Ankara Bilkent City Hospital, 06800 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9261-2669","authenticated-orcid":false,"given":"Habibe Selmin","family":"\u00d6zensoy","sequence":"additional","affiliation":[{"name":"Emergency Department, Ankara Bilkent City Hospital, 06800 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"\u015eervan","family":"G\u00f6khan","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, School of Medicine, Ankara Y\u0131ld\u0131r\u0131m Beyaz\u0131t University, 06800 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8147-5379","authenticated-orcid":false,"given":"Esra F\u0131rat","family":"O\u011fuz","sequence":"additional","affiliation":[{"name":"Department of Medical Biochemistry, Ankara Bilkent City Hospital, 06800 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8649-2493","authenticated-orcid":false,"given":"Funda","family":"Eren","sequence":"additional","affiliation":[{"name":"Department of Medical Biochemistry, Istanbul Basaksehir Cam and Sakura City Hospital, 34000 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1486","DOI":"10.1378\/chest.104.5.1486","article-title":"The incidence of pleural effusion in a well-defined region: Epidemiologic study in central Bohemia","volume":"104","author":"Marel","year":"1993","journal-title":"Chest"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"h4520","DOI":"10.1136\/bmj.h4520","article-title":"The modern diagnosis and management of pleural effusions","volume":"351","author":"Bhatnagar","year":"2015","journal-title":"BMJ"},{"key":"ref_3","first-page":"99","article-title":"Diagnostic approach to pleural effusion","volume":"90","author":"Saguil","year":"2014","journal-title":"Am. 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