Abstract
Procalcitonin remains the most widely adopted sepsis biomarker, but two further candidates -- presepsin and mid-regional
pro-adrenomedullin (MR-proADM) -- are increasingly proposed for roles procalcitonin does not fill well: earlier detection at first
presentation and prognostic risk stratification, respectively. We systematically reviewed 41 studies comparing presepsin,
MR-proADM or both against procalcitonin for sepsis diagnosis, severity stratification or mortality prediction, and organised the
evidence by the specific clinical decision each biomarker is proposed to change rather than by diagnostic accuracy alone.
Presepsin showed a modest but consistent advantage over procalcitonin for very early sepsis detection within the first three hours
of presentation, while MR-proADM outperformed both for 28-day mortality prediction but added little to the initial diagnostic
decision. Neither biomarker's evidence base currently supports replacing procalcitonin outright; the more defensible role for each
is additive, targeted at the specific decision point where procalcitonin itself performs least well.
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