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Meta-Analysis
. 2021 Jan 1;49(1):e80-e90.
doi: 10.1097/CCM.0000000000004738.

Accuracy of Heparin-Binding Protein in Diagnosing Sepsis: A Systematic Review and Meta-Analysis

Yi-Luen Wu  1 , Chia-Hung Yo  2 , Wan-Ting Hsu  3 , Frank Qian  4   5 , Bo-Sheng Wu  6 , Qing-Li Dou  7 , Chien-Chang Lee  8   9
Affiliations
Meta-Analysis

Accuracy of Heparin-Binding Protein in Diagnosing Sepsis: A Systematic Review and Meta-Analysis

Yi-Luen Wu et al. Crit Care Med. .

Abstract

Objectives: Existing studies evaluating the accuracy of heparin-binding protein for the diagnosis of sepsis have been inconsistent. We conducted a systematic review and meta-analysis to assess the totality of current evidence regarding the utility of heparin-binding protein to diagnose sepsis in patients with presumed systemic infection.

Data source: PubMed, Embase, the China National Knowledge infrastructure, and WangFang electronic database were searched from inception to December of 2019.

Study selection: Two independent reviewers identified eligible studies. Cohort and case-control studies, which measured serum levels of heparin-binding protein among adult patients with suspected sepsis, were eligible for inclusion.

Data extraction: Two reviewers independently extracted data elements from the selected studies. A bivariate random-effects meta-analysis model was used to synthesize the prognostic accuracy measures. Risk of bias of studies was assessed with Quality Assessment of Diagnostic Accuracy Studies 2 tool.

Data synthesis: We identified 26 studies with 3,868 patients in the meta-analysis. Heparin-binding protein had a pooled sensitivity of 0.85 (95% CI, 0.79-0.90) and a pooled specificity of 0.91 (95% CI, 0.82-0.96) for the diagnosis of sepsis. There was low heterogeneity between the studies (I2 = 12%), and no evidence of publication bias was detected. Heparin-binding protein had a higher sensitivity and specificity when compared with procalcitonin (0.75 [95% CI, 0.62-0.85] and 0.85 [95% CI, 0.73-0.92]) as well as C-reactive protein (0.75 [95% CI, 0.65-0.84] and 0.71 [95% CI, 0.63-0.77]). Serial measurements of heparin-binding protein also showed that heparin-binding protein levels rose significantly at least 24 hours before a diagnosis of sepsis.

Conclusions: The diagnostic ability of heparin-binding protein is favorable, demonstrating both high sensitivity and specificity in predicting progression to sepsis in critically ill patients. Future studies could assess the incremental value that heparin-binding protein may add to a multimodal sepsis identification and prognostication algorithm for critically ill patients.

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Conflict of interest statement

Drs. Y.-L. Wu’s and Lee’s institutions received funding from Ministry of Science and Technology (MOST) of Taiwan. MOST was not involved in designing the study, collecting, analyzing, or interpreting the data, writing the article, or deciding whether to submit the article for publication. Dr. Chia-Hung Yo received funding from Far Eastern Memorial Hospital (FEMH) (FEMH-2020-C-023). FEMH was not involved in designing the study, collecting, analyzing, or interpreting the data, writing the article, or deciding whether to submit the article for publication. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Comment in

References

    1. Martin GS, Mannino DM, Eaton S, et al. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003; 348:1546–1554
    1. Reinhart K, Daniels R, Kissoon N, et al. Recognizing sepsis as a global health priority - a WHO resolution. N Engl J Med. 2017; 377:414–417
    1. Tiru B, DiNino EK, Orenstein A, et al. The economic and humanistic burden of severe sepsis. Pharmacoeconomics. 2015; 33:925–937
    1. Kim HI, Park S. Sepsis: Early recognition and optimized treatment. Tuberc Respir Dis (Seoul). 2019; 82:6–14
    1. Rivers E, Nguyen B, Havstad S, et al. Early Goal-Directed Therapy Collaborative Group: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001; 345:1368–1377