Tenascin-C, presepsin (SCD14-ST), and neutrophil-to-lymphocyte ratio as complementary circulating biomarkers for sepsis-associated organ dysfunction and 28-day all-cause mortality: A biomarker-enriched prognostic model.

BACKGROUND: Sepsis is characterized by dysregulated host responses with subsequent organ dysfunction. Conventional biomarkers (e.g., procalcitonin) incompletely reflect tissue injury and immune activation. We evaluated the clinical laboratory value of circulating Tenascin-C (TNC), presepsin (sCD14-ST), and the neutrophil-to-lymphocyte ratio (NLR) as complementary biomarkers of organ dysfunction severity and short-term prognosis in sepsis. METHODS: This retrospective observational study enrolled 103 adult ICU patients fulfilling Sepsis-3 criteria (June 2023-June 2025). Peripheral blood was collected within 12 h of ICU admission. Serum TNC was measured by ELISA; sCD14-ST was quantified by chemiluminescent enzyme immunoassay; NLR was calculated from routine blood counts. Associations with organ dysfunction were assessed using Spearman correlation with SOFA scores. Independent associations with 28-day all-cause mortality were examined using multivariable logistic regression. Predictive performance of a clinical baseline model (age, SOFA, PCT) versus a biomarker-enriched model (baseline + TNC, sCD14-ST, NLR) was evaluated by ROC analysis.