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The diagnostic accuracy of presepsin in neonatal sepsis: a meta-analysis

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Abstract

There is growing evidence that presepsin is a promising biomarker in the diagnosis of sepsis in adults. The objective of our study is to investigate current evidence related to the diagnostic accuracy of presepsin in neonatal sepsis. To accomplish this, we searched the Medline (1966–2017), Scopus (2004–2017), Clinicaltrials.gov (2008–2017), EMBASE (1980–2017), Cochrane Central Register of Controlled Trials CENTRAL (1999–2017), and Google Scholar (2004–2017) databases. Eleven studies were included in the present meta-analysis, with a total number of 783 neonates. The pooled sensitivity of serum presepsin for the prediction of neonatal sepsis was 0.91 (95% CI [0.87–0.93]) and the pooled specificity was 0.91 (95% CI [0.88–0.94]). The diagnostic odds ratio was 170.28 (95% CI [51.13–567.11]) and the area under the curve (AUC) was 0.9751 (SE 0.0117). Head-to-head comparison with AUC values of C-reactive protein (0.9748 vs. 0.8580) and procalcitonin (0.9596 vs. 0.7831) revealed that presepsin was more sensitive in detecting neonatal sepsis.

Conclusion: Current evidence support the use of presepsin in the early neonatal period in high-risk populations as its diagnostic accuracy seems to be high in detecting neonatal sepsis.

What is known:

• Neonatal sepsis is a leading cause of morbidity and mortality.

• Current laboratory tests cannot accurately discriminate endangered neonates.

What is new:

• The diagnostic odds ratio of presepsin is 170.28 and the area under the curve is 0.9751.

• According to our meta-analysis, presepsin is a useful protein that may help clinicians identify neonates at risk.

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Abbreviations

95% CI:

95% confidence interval

AUC:

Area under the curve

DOR:

Diagnostic odds ratio

EOS:

Early-onset sepsis

LOS:

Late-onset sepsis

LPS-LBP:

Lipopolysaccharide-lipopolysaccharide binding protein

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

sCD14-ST:

Soluble CD14 subtype

SD:

Standard error

SROC:

Summary receiver operating characteristic

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Authors and Affiliations

  1. Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Athens, Greece

    Ioannis Bellos, Georgia Fitrou, Vasilios Pergialiotis & Despina N. Perrea

  2. Chalandri, Greece

    Vasilios Pergialiotis

  3. First Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Nikolaos Thomakos & Georgios Daskalakis

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  1. Ioannis Bellos
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  2. Georgia Fitrou
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  3. Vasilios Pergialiotis
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  4. Nikolaos Thomakos
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Contributions

Ioannis Bellos performed the meta-analysis and conducted the electronic search.

Georgia Fitrou conducted the electronic search and tabulated the data.

Vasilios Pergialiotis conceived the idea, formed the tables, designed the statistical analysis, and wrote the manuscript.

Despina N. Perrea performed the sensitivity and meta-regression analysis and wrote the manuscript.

Nikolaos Thomakos tabulated data and wrote the manuscript.

Georgios Daskalakis conceived the idea, wrote, and revised the manuscript.

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The authors declare that they have no conflict of interest.

Informed consent

The present systematic review and meta-analysis is based on aggregated data that were retrieved from studies already retrieved. We did not collect individual patient data and did not have direct contact with patients included.

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Communicated by Patrick Van Reempts

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Bellos, I., Fitrou, G., Pergialiotis, V. et al. The diagnostic accuracy of presepsin in neonatal sepsis: a meta-analysis. Eur J Pediatr 177, 625–632 (2018). https://doi.org/10.1007/s00431-018-3114-1

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  • DOI: https://doi.org/10.1007/s00431-018-3114-1

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