Basal procalcitonin, C-reactive protein, interleukin-6, and presepsin for prediction of mortality in critically ill septic patients: a systematic review and meta-analysis

Diagnostic and Prognostic Research

Review

Andres Viteri¹  Daniel Simancas-Racines¹  Laura del Campo-Albendea²  Ingrid Arevalo-Rodriguez²  Borja Fernandez-Felix²  Javier Zamora³  Alfonso Muriel⁴  Jesus Lopez-Alcalde⁵  Xavier Nuvials⁶  Ricard Ferrer⁶  Khalid Saeed Khan⁷  Dimelza Osorio⁸  Daniel Molano-Franco⁹  Guillermo Sanchez^1,10  Ivan Solà^1,11  Ana Alvarez-Méndez^1,12  Silvia Fernández-García^1,13 

[1] Centro de investigación en Salud Pública y Epidemiología Clínica (CISPEC) Facultad de Ciencias de la Salud “Eugenio Espejo”, Universidad UTE, Quito, Ecuador;Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain;Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain;Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK;Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain;Nursing and Physiotherapy Department, University of Alcala, Madrid, Spain;Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain;Universidad Francisco de Vitoria, Pozuelo de Alarcon, Spain;Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland;Critical Care Department, Vall d’Hebron University Hospital, Shock Organ Dysfunction and Resuscitation Research Group (SODIR), Vall d’Hebron Research Institute (VHIR), Barcelona, Spain;Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, CIBER of Epidemiology and Public Health (CIBERESP), Granada, Spain;Health Services Research Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain;Hospital San José, Fundación Universitaria de Ciencias de la Salud (FUCS), CIMCA Research Group, Bogotá, Colombia;Hospital Universitario Mayor-Méderi; Universidad del Rosario, Bogota, Colombia;Iberoamerican Cochrane Centre, IIB SANT PAU, CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain;Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain;WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK;

关键词: Sepsis;    Mortality;    Biomarkers;    Prognostic factors;    Systematic review;   

DOI  :  10.1186/s41512-023-00152-2

 received in 2022-11-29, accepted in 2023-07-13,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundNumerous biomarkers have been proposed for diagnosis, therapeutic, and prognosis in sepsis. Previous evaluations of the value of biomarkers for predicting mortality due to this life-threatening condition fail to address the complexity of this condition and the risk of bias associated with prognostic studies. We evaluate the predictive performance of four of these biomarkers in the prognosis of mortality through a methodologically sound evaluation.MethodsWe conducted a systematic review a systematic review and meta-analysis to determine, in critically ill adults with sepsis, whether procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL-6), and presepsin (sCD14) are independent prognostic factors for mortality. We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials up to March 2023. Only Phase-2 confirmatory prognostic factor studies among critically ill septic adults were included. Random effects meta-analyses pooled the prognostic association estimates.ResultsWe included 60 studies (15,681 patients) with 99 biomarker assessments. Quality of the statistical analysis and reporting domains using the QUIPS tool showed high risk of bias in > 60% assessments. The biomarker measurement as a continuous variable in models adjusted by key covariates (age and severity score) for predicting mortality at 28–30 days showed a null or near to null association for basal PCT (pooled OR = 0.99, 95% CI = 0.99–1.003), CRP (OR = 1.01, 95% CI = 0.87 to 1.17), and IL-6 (OR = 1.02, 95% CI = 1.01–1.03) and sCD14 (pooled HR = 1.003, 95% CI = 1.000 to 1.006). Additional meta-analyses accounting for other prognostic covariates had similarly null findings.ConclusionBaseline, isolated measurement of PCT, CRP, IL-6, and sCD14 has not been shown to help predict mortality in critically ill patients with sepsis. The role of these biomarkers should be evaluated in new studies where the patient selection would be standardized and the measurement of biomarker results.Trial registrationPROSPERO (CRD42019128790).

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

Fig. 9

12974_2023_2864_Article_IEq1.gif

Fig. 2