Diagnostic value of procalcitonin and presepsin for sepsis in critically ill adult patients: a systematic review and meta-analysis

Yutaka Kondo, Yutaka Umemura, Kei Hayashida, Yoshitaka Hara, Morio Aihara, Kazuma Yamakawa, Yutaka Kondo, Yutaka Umemura, Kei Hayashida, Yoshitaka Hara, Morio Aihara, Kazuma Yamakawa

Abstract

Background: Early and accurate diagnosis of sepsis is challenging. Although procalcitonin and presepsin have been identified as potential biomarkers to differentiate between sepsis and other non-infectious causes of systemic inflammation, the diagnostic accuracy of these biomarkers remains controversial. Herein, we performed a comprehensive meta-analysis to assess the overall diagnostic value of procalcitonin and presepsin for the diagnosis of sepsis.

Methods: We searched three electronic databases (MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials) for relevant studies. Two authors independently screened articles on the basis of inclusion and exclusion criteria. The pooled sensitivity, specificity, and summary receiver operating characteristic curves were estimated. The quality of evidence for diagnostic accuracy in absolute effects, i.e., the number of true or false positives and true or false negatives, gave a particular pre-test probability.

Results: We included 19 studies (19 observational studies and no randomized controlled trials) that had enrolled 3012 patients. Analyses of summary receiver operating characteristic curves revealed areas under the receiver operating characteristic curves of 0.84 for procalcitonin and 0.87 for presepsin. The pooled sensitivities and specificities were 0.80 (95% confidence interval 0.75 to 0.84) and 0.75 (95% confidence interval 0.67 to 0.81) for procalcitonin. For presepsin, these values were 0.84 (95% confidence interval 0.80 to 0.88) and 0.73 (95% confidence interval 0.61 to 0.82), respectively. There were no statistically significant differences in both pooled sensitivities (p = 0.48) and specificities (p = 0.57) between procalcitonin and presepsin.

Conclusion: Our meta-analysis provided evidence that the diagnostic accuracy of procalcitonin and presepsin in detecting infection was similar and that both are useful for early diagnosis of sepsis and subsequent reduction of mortality in critically ill adult patients.

Systematic review registration: The study was registered in PROSPERO under the registration number CRD42016035784.

Keywords: Diagnostic test accuracy; Meta-analysis; Presepsin; Procalcitonin; Sepsis; Systematic review.

Conflict of interest statement

Not applicable.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of the identification and selection of studies for inclusion
Fig. 2
Fig. 2
Risk of bias and applicability concerns summary (a) and graph (b), review authors’ judgements about each domain, for each included study
Fig. 3
Fig. 3
Forest plots of PCT and P-SEP for the diagnosis of infection. The plot shows study-specific estimates of sensitivity and specificity with 95% confidence interval (CI). The studies were ordered according to the study names. PCT, procalcitonin; P-SEP, presepsin
Fig. 4
Fig. 4
Summary ROC curves of PCT (the solid line) and P-SEP (the dashed line) for the detection of infection. Each pair of points represents the pair of sensitivity and specificity for each evaluation. PCT, procalcitonin; P-SEP, presepsin. The overall diagnostic accuracy of PCT and P-SEP for infection was moderate and comparable
Fig. 5
Fig. 5
Univariate meta-regression analysis by several possible causes of heterogeneities. PCT, procalcitonin; P-SEP, presepsin. To correct for multiple comparisons with 10 relevant covariates, we considered a p value of < 0.05 as statistical significance. The sensitivity of heterogeneity among included studies might be attributable to several factors, such as risk of bias, publication years, and prevalence of infection
Fig. 6
Fig. 6
Deeks’ funnel plot to estimate the presence of publication bias. PCT, procalcitonin; P-SEP, presepsin; ESS, effective sample size. We detected no evidence of publication bias (PCT: p = 0.67; P-SEP: p = 0.35)

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