Abstract
BACKGROUND: This study aimed to evaluate whether plasma presepsin levels are a more reliable predictor of mortality than traditional infection biomarkers in patients with urinary tract infection (UTI)-related severe infection. METHODS: This single-center retrospective study evaluated 69 patients with UTI-related severe infection admitted to the emergency department between May 2022 and August 2023. Data on vital signs, plasma presepsin levels, procalcitonin (PCT) levels, C-reactive protein (CRP) levels, white blood cell (WBC) count, and other laboratory values at admission were collected. The values of presepsin, PCT, CRP, and WBC count for predicting 28-day mortality were analyzed. Survivors and non-survivors were propensity score-matched in a 2:1 ratio based on age, sex, and estimated glomerular filtration rate. RESULTS: In the overall cohort, presepsin showed the highest area under the receiver operating characteristic curve (AUROC) of 0.716 for predicting 28-day mortality, surpassing that of PCT (0.641), CRP (0.488), and WBC count (0.433). Presepsin levels were independently associated with increased 28-day mortality risk (hazard ratio, 1.026; p = 0.008). In the matched cohort, presepsin levels showed the highest AUROC (0.660), followed by PCT (0.584), CRP (0.496), and WBC count (0.436). CONCLUSIONS: Presepsin levels were independently associated with increased 28-day mortality risk; this may be a valuable biomarker for identifying high-risk patients with UTI-related severe infection. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12894-025-01997-z.