Abstract
Background The soluble cluster of differentiation 14 (or presepsin) is a free fragment of glycoprotein expressed on monocytes and macrophages. Although many studies have been conducted recently, the diagnostic performance of presepsin for sepsis remains debated. We performed a systematic review and meta-analysis of the available literature to assess the accuracy of presepsin for the diagnosis of sepsis in adult patients and compared the performance between presepsin, C-reactive protein (CRP), and procalcitonin (PCT).MethodsA comprehensive systemic search was conducted in PubMed, EMBASE, and Google Scholar for studies that evaluated the diagnostic accuracy of presepsin for sepsis until January 2017. The hierarchical summary receiver operating characteristic method was used to pool individual sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and area under the receiver operating characteristic curve (AUC).ResultsEighteen studies, comprising 3470 patients, met our inclusion criteria. The pooled diagnosis sensitivity and specificity of presepsin for sepsis were 0.84 (95% CI 0.80–0.87) and 0.76 (95% CI 0.67–0.82), respectively. Furthermore, the pooled DOR, PLR, NLR, and AUC were 16 (95% CI 10–25), 3.4 (95% CI 2.5–4.6), 0.22 (95% CI 0.17–0.27), and 0.88 (95% CI 0.85–0.90), respectively. Significant heterogeneity was found in both sensitivities (Cochrane Q = 137.43, p < 0.001, I2 = 87.63%) and specificities (Cochrane Q = 180.76, p < 0.001, I2 = 90.60%). Additionally, we found no significant difference between presepsin and PCT (AUC 0.87 vs. 0.86) or CRP (AUC 0.85 vs. 0.85). However, for studies conducted in ICU, the pooled sensitivity of presepsin was found to be higher than PCT (0.88, 95% CI 0.82–0.92 vs. 0.75, 95% CI 0.68–0.81), while the pooled specificity of presepsin was lower than PCT (0.58, 95% CI 0.42–0.73 vs. 0.75, 95% CI 0.65–0.83).ConclusionBased on the results of our meta-analysis, presepsin is a promising marker for diagnosis of sepsis as PCT or CRP, but its results should be interpreted more carefully and cautiously since too few studies were included and those studies had high heterogeneity between them. In addition, continuing re-evaluation during the course of sepsis is advisable.
Highlights
The soluble cluster of differentiation 14 is a free fragment of glycoprotein expressed on monocytes and macrophages
14 studies were defined as ‘gold standard’ by the criterions defined in the 1991 ACCP/SCCM consensus conference [42], two by the third international consensus definitions for sepsis and septic shock [43], one by Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) [44], and another by American Burn Association (ABA) [45]
The pooled sensitivity of presepsin was found to be higher than PCT in 5 studies conducted in intensive care unit (ICU) comprising 452 patients (0.88, 95% confidence interval (CI) 0.82–0.92 vs. 0.75, 95% CI 0.68– 0.81), while the pooled specificity of presepsin was lower than PCT (0.58, 95% CI 0.42–0.73 vs. 0.75, 95% CI 0.65– 0.83)
Summary
The soluble cluster of differentiation 14 (or presepsin) is a free fragment of glycoprotein expressed on monocytes and macrophages. Studies suggested that the CRP level increases in 4–6 h and reaches the peak in 48–72 h after the inflammatory onset [13], while PCT level increases in 8–24 h and reaches the peak later than 24 h [14]. Both PCT and CRP might be still not reliable enough as early indicators for sepsis used in the clinical context
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