Narrative Review: Research Progress and Future Directions of Presepsin in Neurological Prognostication of Adult Post-Return of Spontaneous Circulation (Post-ROSC) Cardiac Arrest Survivors.

The assessment of neurological prognosis in patients after return of spontaneous circulation (ROSC) following cardiopulmonary resuscitation (CPR) is a critical challenge in critical care medicine. Current prognostic tools (eg, clinical scales, imaging, or traditional biomarkers) have limitations in early accuracy and specificity, leading to uncertainties in treatment decision-making and prognostic communication. Presepsin (soluble CD14 subtype), an emerging inflammation- and infection-related biomarker, has gained increasing attention due to its potential association with post-CPR neurological injury and functional recovery. To address the lack of a systematic synthesis of evidence in this field, this narrative review aims to summarize the biological characteristics of presepsin, its role in neurological prognostic assessment post-CPR, and the underlying mechanisms linking presepsin to neuroinflammation and brain injury. We conducted a narrative synthesis of clinical studies retrieved from PubMed, Embase, and Cochrane Library up to (December 2025, focusing on studies correlating presepsin levels with validated neurological outcome scales. Core findings from synthesized evidence indicate that elevated presepsin levels, particularly within 24-72 hours after return of ROSC, show a consistent and significant association with poor neurological outcome (Cerebral Performance Category (CPC) 3-5) and higher mortality, and presepsin may serve as an independent prognostic factor complementary to existing tools. Major clinical implications include presepsin's potential utility in multimodal prognostic protocols, aiding in early and more accurate outcome prediction. However, significant research gaps persist, including a lack of large-scale, multicenter validation studies, standardized measurement timepoints, and consensus on optimal cutoff values. In conclusion, current evidence supports presepsin as a promising inflammatory biomarker for neurological prognostication after cardiac arrest (CA). Future research must prioritize prospective validation in diverse cohorts and investigate its dynamic changes to establish its definitive role in clinical decision-making.