Presepsin has recently been recognized as a reliable sepsis biomarker; however, its predictive value for mortality in patients with urinary tract infection (UTI) sepsis is unclear. This study aimed to evaluate whether plasma presepsin levels are a more reliable predictor of mortality than traditional infection biomarkers in patients with UTI sepsis. This single-center retrospective study evaluated 44 patients with UTI sepsis who were admitted to the emergency department between May 2022 and August 2023. Data on vital signs, plasma presepsin, procalcitonin (PCT), C-reactive protein (CRP) levels, white blood cell (WBC) count, and other laboratory values at admission were also collected. The values of presepsin, PCT, CRP, and WBC count for predicting 28-day mortality were analyzed. Survivors and nonsurvivors were propensity score-matched in a 1:2 ratio based on age, sex, and estimated glomerular filtration rate. In the overall cohort, presepsin showed the highest area under the receiver operating characteristic (ROC) curve (AUROC) of 0.793 for predicting 28-day mortality, surpassing that of PCT (0.647), CRP (0.616), and WBC count (0.386). High presepsin levels (>1310 pg/mL) were independently associated with an increased risk of 28-day mortality (hazard ratio, 5.438; P=0.019). In the propensity score-matched cohort, the presepsin levels also showed the highest AUROC (0.740), followed by PCT (0.643), CRP (0.636), and WBC count (0.364). High presepsin levels (>825 pg/mL) were independently associated with an increased risk of 28-day mortality. Plasma presepsin levels are significantly associated with mortality and may be valuable biomarker for identifying high-risk patients with UTI sepsis.