Departments of Anesthesiology, Guangxi Medical University Affiliated Tumor Hospital, Naning, Guangxi, China.
Departments of Respiratory Oncology, Guangxi Medical University Affiliated Tumor Hospital, Naning, Guangxi, China.
Crit Care. 2018 Nov 21;22(1):316. doi: 10.1186/s13054-018-2236-1.
Sepsis is an important cause of neonatal morbidity and mortality; therefore, the early diagnosis of neonatal sepsis is essential.
Our aim was to compare the diagnostic accuracy of procalcitonin (PCT), C-reactive protein (CRP), procalcitonin combined with C-reactive protein (PCT + CRP) and presepsin in the diagnosis of neonatal sepsis. We searched seven databases to identify studies that met the inclusion criteria. Two independent reviewers performed data extraction. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), area under curve (AUC), and corresponding 95% credible interval (95% CI) were calculated by true positive (TP), false positive (FP), false negative (FN), and true negative (TN) classification using a bivariate regression model in STATA 14.0 software. The pooled sensitivity, specificity, PLR, NLR, DOR, AUC, and corresponding 95% CI were the primary outcomes. Secondary outcomes included the sensitivity and specificity in multiple subgroup analyses.
A total of 28 studies enrolling 2661 patients were included in our meta-analysis. The pooled sensitivity of CRP (0.71 (0.63, 0.78)) was weaker than that of PCT (0.85 (0.79, 0.89)), PCT + CRP (0.91 (0.84, 0.95)) and presepsin (0.94 (0.80, 0.99)) and the pooled NLR of presepsin (0.06 (0.02, 0.23)) and PCT + CRP (0.10 (0.05, 0.19)) were less than CRP (0.33 (0.26, 0.42)), and the AUC for presepsin (0.99 (0.98, 1.00)) was greater than PCT + CRP (0.96 (0.93, 0.97)), CRP (0.85 (0.82, 0.88)) and PCT (0.91 (0.89, 0.94)). The results of the subgroup analysis showed that 0.5-2 ng/mL may be the appropriate cutoff interval for PCT. A cut-off value > 10 mg/L for CRP had high sensitivity and specificity.
The combination of PCT and CRP or presepsin alone improves the accuracy of diagnosis of neonatal sepsis. However, further studies are required to confirm these findings.
败血症是新生儿发病率和死亡率的重要原因；因此，早期诊断新生儿败血症至关重要。
我们旨在比较降钙素原（PCT）、C 反应蛋白（CRP）、PCT 联合 CRP（PCT+CRP）和前降钙素（Presepsin）在诊断新生儿败血症中的诊断准确性。我们检索了七个数据库以确定符合纳入标准的研究。两名独立的审查员进行了数据提取。使用 STATA 14.0 软件中的双变量回归模型，根据真阳性（TP）、假阳性（FP）、假阴性（FN）和真阴性（TN）分类，计算汇总灵敏度、特异性、阳性似然比（PLR）、阴性似然比（NLR）、诊断比值比（DOR）、曲线下面积（AUC）和相应的 95%可信区间（95%CI）。汇总灵敏度、特异性、PLR、NLR、DOR、AUC 和相应的 95%CI 是主要结局。次要结局包括多项亚组分析中的灵敏度和特异性。
共有 28 项研究纳入了 2661 名患者，纳入了我们的荟萃分析。CRP 的汇总敏感性为 0.71（0.63，0.78），弱于 PCT（0.85（0.79，0.89））、PCT+CRP（0.91（0.84，0.95））和 Presepsin（0.94（0.80，0.99）），Presepsin 的汇总 NLR（0.06（0.02，0.23））和 PCT+CRP（0.10（0.05，0.19））均小于 CRP（0.33（0.26，0.42）），Presepsin 的 AUC 为 0.99（0.98，1.00）大于 PCT+CRP（0.96（0.93，0.97））、CRP（0.85（0.82，0.88））和 PCT（0.91（0.89，0.94））。亚组分析结果表明，0.5-2ng/mL 可能是 PCT 的合适截断值。CRP 的截断值>10mg/L 具有较高的灵敏度和特异性。
PCT 与 CRP 联合或单独使用 Presepsin 可提高新生儿败血症的诊断准确性。但是，需要进一步的研究来证实这些发现。
