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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Ann+Intensive+Care
2017 ; 7
(1
): 91
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Comparison of diagnostic accuracy in sepsis between presepsin, procalcitonin, and
C-reactive protein: a systematic review and meta-analysis
#MMPMID28875483
Wu CC
; Lan HM
; Han ST
; Chaou CH
; Yeh CF
; Liu SH
; Li CH
; Blaney GN 3rd
; Liu ZY
; Chen KF
Ann Intensive Care
2017[Sep]; 7
(1
): 91
PMID28875483
show ga
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). METHODS: A 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). RESULTS: Eighteen 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, I (2) = 87.63%) and
specificities (Cochrane Q = 180.76, p < 0.001, I (2) = 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). CONCLUSION: Based
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.