Biomarkers and Point-of-Care Innovation in the Emergency Department

Biomarkers are essential tools in the emergency department for improving early detection, risk stratification, and patient management. This article reviews challenges in biomarker integration, the diagnostic and prognostic value of pancreatic stone protein (PSP), and the role of point-of-care solutions such as the abioSCOPE® in advancing personalised emergency medicine.

Introduction

Emergency departments (EDs) are under constant pressure to rapidly identify, triage, and treat patients presenting with acute and often life-threatening conditions. Clinicians are expected to make decisions based on limited information and under strict time constraints, which increases the risk of delayed or missed diagnoses. Biomarkers have been proposed as critical tools to support clinical judgment, enabling early disease detection, risk stratification, and treatment monitoring.

However, the clinical integration of biomarkers in the ED remains challenging. Conventional markers such as troponin, D-dimer, BNP/NT-proBNP, and procalcitonin are widely used, but concerns limited availability, and false positives have restricted their impact (Luka et al. 2025). Also, current evidence largely derives from retrospective studies rather than prospective validation, limiting their utility for guiding patient care in real-world settings (Ware et al. 2017). That is why there is a growing interest in identifying novel biomarkers that not only improve diagnostic accuracy but also integrate seamlessly into ED workflows.

Pancreatic stone protein (PSP) has emerged as a promising candidate, with an expanding body of evidence supporting its diagnostic and prognostic value in sepsis and other critical conditions. This article reviews the challenges of biomarker use in the ED, examines PSP as a novel biomarker, particularly in combination with other clinical tools, and discusses the role of the abioSCOPE® as a point-of-care solution for PSP testing.

Biomarkers in Early Detection: Challenges and Opportunities

The use of biomarkers in the ED is well established. However, these biomarkers are not without limitations. Challenges such as cost, availability, and accuracy concerns are consistent with global literature emphasising the need for scalable and reliable diagnostic tools in high-pressure settings (Luka et al. 2025).

Personalised medicine in critical illness represents the next frontier, with biomarkers forming the foundation of precision approaches to sepsis, acute respiratory distress syndrome (ARDS), and acute kidney injury. The ED presents unique challenges, as patients often present with nonspecific symptoms and limited clinical history. In this setting, biomarkers that are both rapid and reliable are needed to complement clinical risk scores and support triage decisions (Schuetz et al. 2015).

Pancreatic Stone Protein: A Novel Biomarker in Sepsis

Diagnostic and Prognostic Value

PSP has gained significant attention as a versatile biomarker with applications across sepsis, infection, and critical care populations. Several studies have demonstrated its ability to predict sepsis earlier than other biomarkers (Pugin et al. 2021; Klein et al. 2020; Niggemann et al. 2021; Klein et al. 2021; Belletti et al. 2025). 

In a large multicentre investigation, Pugin et al. (2021) reported that PSP levels increased significantly and earlier than other inflammatory biomarkers in patients with sepsis. PSP values correlated with disease severity and clinical outcomes, allowing for earlier identification of patients at risk of organ dysfunction. The study highlighted that PSP could discriminate between sepsis and non-infectious causes of systemic inflammation, supporting its use for both diagnosis and early risk stratification.

Studies in burn ICU patients found that PSP levels remain stable after burn injury and surgical procedures, unlike CRP and PCT, which rise with inflammatory or surgical stress, suggesting PSP is a more specific sepsis marker (Klein et al. 2020). In another burn cohort, PSP increased 3.3–5.5-fold up to 72 hours before sepsis diagnosis (Niggemann et al. 2021) and was the strongest indicator of sepsis in patients with inhalation injury and ARDS (Klein et al. 2021).

Meta-analyses and systematic reviews highlight PSP's superiority over traditional markers. PSP outperformed C-reactive protein (CRP) in infection diagnosis, and the combination of PSP with CRP further improved accuracy (Prazak et al. 2021). This synergistic approach suggests that PSP may be best deployed not as a standalone biomarker but as part of a multimodal diagnostic strategy.

These findings demonstrate that PSP provides earlier and more accurate detection of sepsis compared with traditional biomarkers, making it particularly valuable in the ED, where timely recognition and intervention are essential for improving patient outcomes. The findings are supported by targeted analyses in specific populations, including patients requiring mechanical circulatory support, where PSP demonstrated relevance in predicting infection risk and guiding clinical management (Belletti et al. 2025).

Integration With Clinical Scores

The role of PSP extends beyond direct biomarker comparison. Integrating PSP with ED clinical scores, such as those used for sepsis triage and risk stratification, has the potential to significantly enhance performance. Personalised, biomarker-guided emergency medicine with PSP in combination with established scoring systems could provide clinicians with actionable insights at the point of care (Arturi et al. 2025).

A study of 285 patients (148 with suspected sepsis, 137 with sepsis) compared PSP, procalcitonin (PCT), and SOFA score. PSP and PCT showed similar diagnostic accuracy for sepsis. Sepsis was more common when both biomarkers were elevated (89%) versus when one or neither was elevated (21–48%). Higher biomarker quartiles correlated with worse SOFA scores and poorer outcomes. Adding PSP to SOFA improved risk prediction, with PSP showing particular strength in predicting kidney replacement therapy. While neither biomarker independently predicted outcomes, PSP demonstrated diagnostic and prognostic value, especially for kidney dysfunction, and could complement existing clinical assessments (Lee et al. 2024).

Economic Benefits

Sepsis places a substantial economic burden on healthcare systems. In high-income countries, the average hospital cost of sepsis exceeds US $32,000 per patient (World Health Organization 2024). A cost-impact model evaluated rapid PSP testing in U.S. ED and ICU settings and showed that, compared with standard care, PSP testing reduced costs by $1,688 per patient in the ED and $3,315 per patient in the ICU, primarily through improved diagnostic sensitivity and specificity. When extrapolated nationally, sepsis-related costs were estimated at $40.8 billion with standard care versus $37.7 billion with PSP-guided care, yielding $3.1 billion in savings (Schneider et al. 2022).

These findings highlight how incorporating PSP testing can alleviate the financial strain of sepsis by reducing unnecessary resource utilisation, supporting both better patient outcomes and more sustainable healthcare delivery in resource-constrained, high-throughput environments such as the ED.

The abioSCOPE®: Bridging the Gap Between Science and Clinical Practice

The abioSCOPE® is a point-of-care platform specifically developed for rapid PSP testing, delivering laboratory-quality results from just one drop of blood in minutes. By enabling PSP measurement directly at the bedside, it provides clinicians in emergency settings with fast, accurate, and actionable information where speed and ease of use are critical. This immediate integration of PSP biomarker data into clinical workflows is particularly valuable in the ED, where delayed results can hinder timely intervention. Evidence suggests that PSP-guided approaches have the potential to reduce healthcare expenditure by promoting earlier intervention and optimising resource allocation.

Conclusion

Biomarkers have long been considered key to advancing emergency medicine, yet challenges in availability, cost, and clinical validation have limited their widespread adoption. PSP represents a significant step forward, with strong evidence supporting its diagnostic, prognostic, and integrative potential. When combined with clinical scores, PSP enhances risk stratification and could play a key role in ED triage.

The translation of this evidence into clinical practice is now made possible by the abioSCOPE®, a point-of-care platform that delivers rapid, reliable PSP measurements from a single drop of blood. With several ongoing studies investigating the role of PSP in ED triage, the integration of PSP into personalised emergency medicine is on the horizon.

Disclaimer

Point-of-view articles are the sole opinion of the author(s) and are part of the ICU Management & Practice Corporate Engagement or Educational Community Programme.