Presepsin level as risk factor for mortality in premature infants with neonatal sepsis

Main Article Content

Muhammad Ifan Romli
Tetty Yuniati
Dany Hilmanto


Background Prematurity is a risk factor of neonatal sepsis and its associated morbidities and mortality. Most deaths in neonatal sepsis occur within the first seven days. Presepsin has been reported as one of the earliest biomarkers for predicting mortality.

Objective To determine the association between presepsin levels and mortality risk, as well as the optimal presepsin cut-off point for predicting mortality, in premature infants with neonatal sepsis

.Method This was an observational prospective cohort study on 62 preterm infants born at 28 to <37 weeks’ gestation. We recorded clinical and laboratory characteristics, performed blood culture, and measured presepsin levels at initial diagnosis of sepsis. Subjects were followed for seven days and their outcome (death or survival) recorded. We evaluated the association between clinical and laboratory characteristics, including presepsin levels, with sepsis outcome. We also constructed a receiver-operator characteristics curve to determine the optimal cut-off point of presepsin as a predictor of sepsis mortality.

Results Only blood culture results (P=0.006) and presepsin level (P<0.001) were significantly associated with sepsis outcome on the seventh day. The optimal presepsin cut-off value for predicting mortality was 1057 ng/mL, with an area under curve of 80.4%, sensitivity of 60.71%, and specificity of 88.24%. A presepsin level of >1057 ng/mL was associated with increased mortality [RR 3.02; 95%CI  68.3 to 89.4; P<0.001].

Conclusion In preterm infants with neonatal sepsis, an elevated presepsin level at diagnosis is a significant risk factor for mortality within seven days. Presepsin can be used as an early biomarker of sepsis outcome.

Article Details

How to Cite
Romli M, Yuniati T, Hilmanto D. Presepsin level as risk factor for mortality in premature infants with neonatal sepsis. PI [Internet]. 21Jun.2021 [cited 25Jul.2021];61(3):165-0. Available from:
Received 2021-03-11
Accepted 2021-06-21
Published 2021-06-21


1. Haque KN. Neonatal sepsis in the very low birth weight preterm infants: Part 2: Review of definition, diagnosis and management. J Med Sci. 2010;3:11 ̶ 27.
2. Shane AL, Stoll BJ. Neonatal sepsis: progress towards improved outcomes. J Infect. 2014;68:S24 ̶-32. DOI: 10.1016/j.jinf.2013.09.011.
3. Russell ARB. Neonatal sepsis. J Paediatr Child Health. 2011;21:265-9. DOI: 10.1016/j.paed.2010.11.003.
4. Muhe LM, McClure EM, Nigussie AK, Mekasha A, Worku B, Worku A, et al. Major cause of death in preterm infants in selected hospitals in Ethiopia (SIP): a prospective, cross- sectional, observational study. Lancet. 2019;7: e1130-38. DOI: 10.1016/S2214-109X(19)30220-7.
5. Putra PJ. Insiden dan faktor-faktor yang berhubungan dengan sepsis neonatus di RSUP Sanglah Denpasar. Sari Pediatri. 2016;14:205-10. DOI: 10.14238/sp14.3.2012.205-10.
6. Dimitri A. Neonatal Sepsis: Looking Beyond the Blood Culture. Arch Pediatr Adolesc Med. 2009;163:12-5. DOI: 10.1001/archpediatrics.2008.515.
7. Kim SJ, Kim GA, Park JH, Lee SL, Kim CS. Clinical features and prognostic factors of early-onset sepsis: a 7.5-year experience in one neonatal intensive care unit. Korean J Pediatr. 2019;62:36-41. DOI: 10.3345/kjp.2018.06807.
8. Satar M, Engin Arısoy A, Çelik İH. Turkish neonatal society guideline on neonatal infections - diagnosis and treatment. Turk Pediatr Ars. 2018;53Suppl 1:S88-100. DOI: 10.5152/TurkPediatriArs.2018.01809.
9. Astrawinata DAW, Kaban RK, Roeslani RD, Parmawati E. The role of presepsin, C-reactive protein and procalcitonin as a marker of therapy response and prognosis for late onset neonatal sepsis in preterm neonates. J Med Sci Clin Res. 2017;05:26681-90. DOI: 10.18535/jmscr/v5i8.116.
10. WHO recommendations on antenatal care for a positive pregnancy experience. WHO. 2016. [cited 2021 01 02}. Available from:
11. Cosar H, Yilmaz O, Temur M, Ozun O, Bulut Y. Relationship between early-onset neonatal sepsis and red blood cell distribution width (RDW). J Hematol Thrombo Dis. 2017;5:1-5. DOI: 10.4172/2329-8790.1000266.
12. Parri N, Trippella G, Lisi C, De Martino M, Galli L, Chiappini E. Accuracy of presepsin in neonatal sepsis: systematic review and meta-analysis. Expert Rev Anti Infect Ther. 2019;17:223-32. DOI: 10.1080/14787210.2019.1584037.
13. Deǧirmencioǧlu H, Ozer Bekmez B, Derme T, Öncel MY, Canpolat FE, Tayman C. Presepsin and fetuin-A dyad for the diagnosis of proven sepsis in preterm neonates. BMC Infect Dis. 2019;19:1-7. DOI: 10.1186/s12879-019-4316-5.
14. Poggi C, Bianconi T, Gozzini E, Generoso M, Dani C. Presepsin for the detection of late-onset sepsis in preterm newborns. Pediatrics. 2015;135:68-75. DOI: 10.1542/peds.2014-1755.
15. Montaldo P, Rosso R, Santantonio A, Chello G, Giliberti P. Presepsin for the detection of early-onset sepsis in preterm newborns. Pediatr Res. 2017;81:329-34. DOI: 10.1038/pr.2016.217.
16. Gad GI, Shinkar DM, El-din MMK, Nagi HM. The Utility of Soluble CD14 Subtype in Early Diagnosis of Culture-Proven Early-Onset Neonatal Sepsis and Prediction of Outcome. Am J Perinatol. 2019;00:1-6. DOI: 10.1055/s-0039-1683863.
17. Galliera E, Massaccesi L, Vecchi E De, Banfi G, Romanelli MMC. Clinical application of presepsin as diagnostic biomarker of infection: overview and updates. Clin Chem Lab Med. 2020;58:11-7. DOI: 10.1515/cclm-2019-0643.