The accuracy assessment of presepsin (sCD14-ST) for mortality prediction in adult patients with sepsis and a head-to-head comparison to PCT: a meta-analysis

Therapeutics and Clinical Risk Management Dovepress open access to scientific and medical research Therapeutics and Clinical Risk Management downloaded from https://www.dovepress.com/ by 88.198.20.149 on 03-Aug-2019 For personal use only. Open Access Full Text Article The accuracy assessment of presepsin (sCD14-ST) for mortality prediction in adult patients with sepsis and a head-to-head comparison to PCT: a meta-analysis This article was published in the following Dove Press journal: Therapeutics and Clinical Risk Management Ying Zhu 1,2 Xuehui Li 1 Peiyan Guo 1 Yuhan Chen 3 Jiandong Li 1 Tianzhu Tao 4 1 Department of Respiratory Medicine, The Seventh Medical Center of PLA General Hospital, Beijing, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, People’s Republic of China; 3 Affiliated BaYi Children’s Hospital, The Seventh Medical Center of PLA General Hospital, Beijing, People’s Republic of China; 4Department of Anesthesiology, Air Force Medical Center, PLA, Beijing, People’s Republic of China Correspondence: Jiandong Li Department of Respiratory Medicine, The Seventh Medical Center of PLA General Hospital, 5 Nanmencang, Dongcheng District, Beijing 100700, People’s Republic of China Tel +86 108 400 8044 Email Objective: The soluble cluster of differentiation 14 subtype (sCD14-ST) or presepsin has recently been identified as a promising biomarker in sepsis. The present meta-analysis is performed to assess the prognostic value of presepsin in septic patients. Further, we compare the prognostic performance between presepsin and procalcitonin (PCT) in predicting allcause mortality in these patients. Methods: A systemic and comprehensive search was conducted in PubMed, Embase and Cochrane databases by using Exploded Medical Subject Headings and appropriate corresponding keywords. Studies were eligible if they assessed the prognostic value of presepsin in sepsis and provided sufficient information to construct a 2×2 contingency table. A bivariate meta-analysis model was used to calculate the pooled sensitivity, specificity, positive/negative likelihood ratios and diagnostic odds ratio. The Chi-square and I2 index were used to assess the heterogeneity and inconsistency. The Deek’s funnel plot asymmetry test was used to assess the likelihood of publication bias. Results: Nine publications, comprising 1,561 patients, were included in this study. The overall area under the receiver operating characteristic curve (AUROC) of presepsin was 0.77 (95% CI, 0.73–0.81) with a pooled prognostic sensitivity (SEN) and specificity (SPE) of 0.83 (95% CI, 0.72–0.90) and 0.69 (95% CI, 0.63–0.74), respectively. Additionally, the PLR, NLR and DOR of presepsin were 2.6 (95% CI, 2.1–3.3), 0.25 (95% CI, 0.15–0.44) and 10 (95% CI, 5–22), respectively. The AUROC of PCT was 0.81 (95% CI, 0.78–0.84) with a pooled SEN of 0.76 (95% CI, 0.55–0.89) and SPE of 0.74 (95% CI, 0.33–0.94). There is no statistically significant difference in the performance of pooled SEN and SPE between presepsin and PCT, with a p value of 0.39 and 0.71, respectively. Conclusions: Based on the results of this meta-analysis, both presepsin and PCT are promising biomarkers for the prognosis of mortality in sepsis. Keywords: presepsin, sCD14-ST, procalcitonin, prognostic, sepsis, mortality Introduction Tianzhu Tao Department of Anesthesiology, Air Force Medical Center, PLA, 30 Fucheng Road, Haidian District, Beijing 100142, People’s Republic of China Tel +86 106 692 8487 Email Sepsis is a life-threatening organ dysfunction characterized by a dysregulated host response to infection. Sepsis accounts for about 25% of intensive care unit (ICU) admissions, with a mortality range from 10% to 52%.1–3 Despite advances and breakthroughs in antibiotic treatment or other managements of bundled care for the patients with sepsis, the fatality rate remains unacceptably high and the incidence is submit your manuscript | www.dovepress.com Therapeutics and Clinical Risk Management 2019:15 741–753 DovePress © 2019 Zhu et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://doi.org/10.2147/TCRM.S198735 Powered by TCPDF (www.tcpdf.org) ORIGINAL RESEARCH 741 Dovepress Therapeutics and Clinical Risk Management downloaded from https://www.dovepress.com/ by 88.198.20.149 on 03-Aug-2019 For personal use only. Zhu et al still increasing.4,5 To improve sepsis-related survival, it is imperative to early recognize septic patients at high risk of poor clinical outcomes. However, due to the lack of an ideal prognostic indicator, timely identification of patients at risk of dying from the condition is challenging. To identify mortality risk and ensure the appropriate therapeutic interventions, clinical scores have been introduced. In clinical practice, the most commonly used clinical scores are the Acute Physiology and Chronic Health Evaluation (APACHE) II score and Sequential Organ Failure Assessment (SOFA) score.6,7 They are validated as the most recognized tools to stratify the severity of the condition. However, with the increasing controversies and complicated methods for using these clinical scoring systems, a growing body of evidence has proposed blood biomarkers as promising alternatives.8 Hundreds of the circulating biomarkers have been investigated for potential use in improving early diagnosis and monitoring the outcome of septic patients.9–11 However, due to the controversial and uncertain factors in clinical value, fewer biomarkers were used in the practical medical work. Among the most extensively studied in recent years, PCT, CRP, pentraxin-3, IL-6 and myeloid cells expressing triggering receptor-1 (TREM-1) have been identified as probable predictors in sepsis.12–14 Among those, procalcitonin (PCT) is considered as the most preferable biological predictors and is a widely recognized biomarker in predicting outcomes in septic patients.15,16 Presepsin, a truncated N-terminal fragment of CD14, also known as soluble cluster of differentiation 14 subtype (sCD14-ST), has recently attracted great clinical interest and risen up as a promising prognostic serum marker in sepsis. The generation and release of the presepsin are cleaved from the monocyte/macrophage-specific CD14 receptor complex which is binding with bacterial lipopolysaccharide (LPS) and LPS binding protein (LPB) d (...truncated)