血清淀粉样蛋白前体作为儿童和青少年脓毒症的诊断标志物：系统评价和荟萃分析。
Presepsin as a diagnostic marker of sepsis in children and adolescents: a systemic review and meta-analysis.
机构信息
Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea.
出版信息
BMC Infect Dis. 2019 Aug 30;19(1):760. doi: 10.1186/s12879-019-4397-1.
BACKGROUND
Early diagnosis of sepsis in pediatric patients is vital but remains a major challenge. Previous studies showed that presepsin is potentially a reliable diagnostic biomarker for sepsis in adult and neonates. However, there is no pooled analysis of its efficacy as a diagnostic biomarker for sepsis in children. The aims of the present meta-analysis were to assess the overall diagnostic accuracy of presepsin in pediatric sepsis and compare it to those for C-reactive protein (CRP) and procalcitonin (PCT).
METHODS
A systematic literature search was performed in Medline/Pubmed, Embase, the Cochrane Library, and ISI Web of Science to identify relevant studies reporting the diagnostic accuracy of presepsin in patients with pediatric sepsis. Sensitivities and specificities were pooled by bivariate meta-analysis. Heterogeneity was evaluated by χ test.
RESULTS
We identified 129 studies in total. Most were disqualified on the basis of their titles/abstracts and duplication. Four studies were included in the final analysis. They comprised 308 patients aged between 1 mo and 18 y. The pooled diagnostic sensitivity and specificity of presepsin were 0.94 (95% confidence interval [CI]: 0.74-0.99) and 0.71 (95% CI: 0.35-0.92), respectively. The pooled diagnostic odds ratio, positive likelihood ratio (LR), and negative LR of presepsin were 32.87 (95% CI: 2.12-510.09), 3.24 (95% CI, 1.14-12.38), and 0.08 (95% CI, 0.01-0.74), respectively. Heterogeneity was found in both sensitivity (χ = 11.17; P = 0.011) and specificity (χ = 65.78; P < 0.001). No threshold effect was identified among the studies (r = - 0.938). The pooled sensitivity of presepsin (0.94) was higher than that of CRP (0.51) and PCT (0.76), whereas the overall specificity of presepsin (0.71) was lower than that of CRP (0.81) and PCT (0.76). The AUC of presepsin (0.925) was higher than that of CRP (0.715) and PCT (0.820).
CONCLUSION
Currently available evidence indicates that presepsin has higher sensitivity and diagnostic accuracy, but lower specificity, than PCT or CRP in detecting sepsis in children. However, these results must be carefully interpreted as the number of studies included was small and the studies were statistically heterogeneous.
背景
早期诊断儿童脓毒症至关重要，但仍是一大挑战。既往研究显示，降钙素原前肽（Presepsin）可能是成人和新生儿脓毒症的一种可靠诊断生物标志物。然而，目前尚无 Presepsin 作为儿童脓毒症诊断生物标志物的汇总分析。本荟萃分析旨在评估 Presepsin 对儿童脓毒症的总体诊断准确性，并与 C 反应蛋白（CRP）和降钙素原（PCT）进行比较。
方法
通过 Medline/Pubmed、Embase、Cochrane 图书馆和 ISI Web of Science 进行系统文献检索，以确定报道 Presepsin 对儿童脓毒症患者诊断准确性的相关研究。通过双变量荟萃分析汇总敏感度和特异度。通过 χ²检验评估异质性。
结果
共确定了 129 项研究。根据标题/摘要和重复情况，大多数研究被排除在外。最终有 4 项研究纳入分析，共纳入 308 名年龄在 1 个月至 18 岁的患者。Presepsin 的汇总诊断敏感度和特异度分别为 0.94（95%置信区间[CI]：0.74-0.99）和 0.71（95% CI：0.35-0.92）。Presepsin 的汇总诊断优势比、阳性似然比（LR）和阴性 LR 分别为 32.87（95% CI：2.12-510.09）、3.24（95% CI，1.14-12.38）和 0.08（95% CI，0.01-0.74）。敏感度（χ²=11.17；P=0.011）和特异度（χ²=65.78；P<0.001）均存在异质性。研究中未发现阈值效应（r=-0.938）。Presepsin 的汇总敏感度（0.94）高于 CRP（0.51）和 PCT（0.76），而 Presepsin 的总体特异度（0.71）低于 CRP（0.81）和 PCT（0.76）。Presepsin 的 AUC（0.925）高于 CRP（0.715）和 PCT（0.820）。
结论
目前的证据表明，Presepsin 检测儿童脓毒症的敏感度和诊断准确性高于 PCT 或 CRP，但特异性低于 PCT 或 CRP。然而，由于纳入的研究数量较少且存在统计学异质性，因此必须仔细解释这些结果。
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