Abstract
ObjectivePresepsin is a novel biomarker to diagnose sepsis but its prognostic value has not been comprehensively reviewed. We conducted this meta-analysis to evaluate the mortality prediction value of presepsin in sepsis.MethodsWe searched comprehensive electronic databases from PubMed, EMBASE, and Cochrane Library through September 2017 using the key words of (‘presepsin’ or ‘sCD14-ST’ or ‘soluble CD14 subtype’) and (‘sepsis’ or ‘septic shock’) and (‘prognosis’ or ‘prognostic value’ or ‘prognostic biomarker’ or ‘mortality’). We extracted the presepsin levels in survivors and non-survivors from each individual study and evaluated the standardized mean difference (SMD) using a web-based meta-analysis with the R statistical analysis program.ResultsA total of 10 studies and 1617 patients were included. Presepsin levels in the first sampling (within 24 hours) were significantly lower among survivors as compared with non-survivors: the pooled SMD between survivors and non-survivors was 0.92 (95% CI: 0.62–1.22) in the random effects model (I2 = 79%, P< 0.01). In subgroups, divided by the sepsis severity or study site, pooled SMD was consistently noting higher presepsin levels in non-survivals (P< 0.05).ConclusionThis meta-analysis demonstrates some mortality prediction value in presepsin in patients with sepsis. Further studies are needed to define the optimal cut-off point to predict mortality in sepsis.
Highlights
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection [1]
Presepsin levels in the first sampling were significantly lower among survivors as compared with non-survivors: the pooled standardized mean difference (SMD) between survivors and non-survivors was 0.92 in the random effects model (I2 = 79%, P< 0.01)
To promptly recognize and manage higher risk patients, several risk stratification models have been adopted such as Sequential Organ Failure Assessment (SOFA) [5], Acute Physiology And Chronic Health Evaluation (APACHE) [6]or Mortality in Emergency Department Sepsis (MEDS) [7] scores
Summary
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection [1]. To promptly recognize and manage higher risk patients, several risk stratification models have been adopted such as Sequential Organ Failure Assessment (SOFA) [5], Acute Physiology And Chronic Health Evaluation (APACHE) [6]or Mortality in Emergency Department Sepsis (MEDS) [7] scores. Presepsin can be detected by biochemical methods and has been considered an emergent biomarker of infection. In 2015, its diagnostic accuracy in sepsis was confirmed by meta-analysis [10,11,12], but the prognostic accuracy of presepsin in sepsis was only reported in individual clinical studies, some showing significantly lower early presepsin levels in survivors compared with non-survivors [13,14,15,16,17,18,19,20,21], others not [22, 23]
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