Diagnostic value of procalcitonin and presepsin for sepsis in critically ill adult patients: a systematic review and meta-analysis

Journal of Intensive Care

Yoshitaka Hara¹  Yutaka Kondo²  Kei Hayashida³  Morio Aihara⁴  Yutaka Umemura⁵  Kazuma Yamakawa⁶ 

[1] Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine;Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital;Department of Emergency and Critical Care Medicine, Keio University School of Medicine;Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine;Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine;Division of Trauma and Surgical Critical Care, Osaka General Medical Center;

关键词: Sepsis;    Procalcitonin;    Presepsin;    Diagnostic test accuracy;    Systematic review;    Meta-analysis;   

DOI  :  10.1186/s40560-019-0374-4

来源: DOAJ

【 摘 要 】

Abstract Background Early and accurate diagnosis of sepsis is challenging. Although procalcitonin and presepsin have been identified as potential biomarkers to differentiate between sepsis and other non-infectious causes of systemic inflammation, the diagnostic accuracy of these biomarkers remains controversial. Herein, we performed a comprehensive meta-analysis to assess the overall diagnostic value of procalcitonin and presepsin for the diagnosis of sepsis. Methods We searched three electronic databases (MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials) for relevant studies. Two authors independently screened articles on the basis of inclusion and exclusion criteria. The pooled sensitivity, specificity, and summary receiver operating characteristic curves were estimated. The quality of evidence for diagnostic accuracy in absolute effects, i.e., the number of true or false positives and true or false negatives, gave a particular pre-test probability. Results We included 19 studies (19 observational studies and no randomized controlled trials) that had enrolled 3012 patients. Analyses of summary receiver operating characteristic curves revealed areas under the receiver operating characteristic curves of 0.84 for procalcitonin and 0.87 for presepsin. The pooled sensitivities and specificities were 0.80 (95% confidence interval 0.75 to 0.84) and 0.75 (95% confidence interval 0.67 to 0.81) for procalcitonin. For presepsin, these values were 0.84 (95% confidence interval 0.80 to 0.88) and 0.73 (95% confidence interval 0.61 to 0.82), respectively. There were no statistically significant differences in both pooled sensitivities (p = 0.48) and specificities (p = 0.57) between procalcitonin and presepsin. Conclusion Our meta-analysis provided evidence that the diagnostic accuracy of procalcitonin and presepsin in detecting infection was similar and that both are useful for early diagnosis of sepsis and subsequent reduction of mortality in critically ill adult patients. Systematic review registration The study was registered in PROSPERO under the registration number CRD42016035784.

【 授权许可】

Unknown