Zhu Ying, Li Xuehui, Guo Peiyan, Chen Yuhan, Li Jiandong, Tao Tianzhu
Department of Respiratory Medicine, The Seventh Medical Center of PLA General Hospital, Beijing, People's Republic of China.
Department of Respiratory and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, People's Republic of China.
Ther Clin Risk Manag. 2019 Jun 13;15:741-753. doi: 10.2147/TCRM.S198735. eCollection 2019.
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 all-cause mortality in these patients. 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 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. 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 value of 0.39 and 0.71, respectively. Based on the results of this meta-analysis, both presepsin and PCT are promising biomarkers for the prognosis of mortality in sepsis.
可溶性分化簇14亚型（sCD14-ST）即可溶性髓系细胞触发受体-1最近被确定为脓毒症中有前景的生物标志物。本荟萃分析旨在评估可溶性髓系细胞触发受体-1在脓毒症患者中的预后价值。此外，我们比较了可溶性髓系细胞触发受体-1和降钙素原（PCT）在预测这些患者全因死亡率方面的预后性能。通过使用展开的医学主题词和适当的相应关键词，在PubMed、Embase和Cochrane数据库中进行了系统全面的检索。如果研究评估了可溶性髓系细胞触发受体-1在脓毒症中的预后价值并提供了足够信息以构建2×2列联表，则该研究符合纳入标准。使用双变量荟萃分析模型计算合并敏感度、特异度、阳性/阴性似然比和诊断比值比。采用卡方检验和I²指数评估异质性和不一致性。使用Deek漏斗图不对称性检验评估发表偏倚的可能性。本研究纳入了9篇文献，共1561例患者。可溶性髓系细胞触发受体-1的受试者工作特征曲线下的总面积（AUROC）为0.77（95%CI，0.73 - 0.81），合并预后敏感度（SEN）和特异度（SPE）分别为0.83（95%CI，0.72 - 0.90）和0.69（95%CI，0.63 - 0.74）。此外，可溶性髓系细胞触发受体-1的阳性似然比、阴性似然比和诊断比值比分别为2.6（95%CI，2.1 - 3.3）、0.25（95%CI，0.15 - 0.44）和10（95%CI，5 - 22）。降钙素原的AUROC为0.81（95%CI，0.78 - 0.84），合并SEN为0.76（95%CI，0.55 - 0.89），SPE为0.74（95%CI，0.33 - 0.94）。可溶性髓系细胞触发受体-1和降钙素原在合并SEN和SPE性能方面无统计学显著差异，I²值分别为0.39和0.71。基于本荟萃分析结果，可溶性髓系细胞触发受体-1和降钙素原都是脓毒症死亡率预后的有前景的生物标志物。
