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Meta-Analysis
. 2023 Dec 12:14:1320683.
doi: 10.3389/fimmu.2023.1320683. eCollection 2023.

Diagnostic efficacy of serum presepsin for postoperative infectious complications: a meta-analysis

Chun-Ying Lu #  1 , Chia-Li Kao  2 , Kuo-Chuan Hung #  1 , Jheng-Yan Wu  3 , Hui-Chen Hsu  4 , Chia-Hung Yu  1 , Wei-Ting Chang  5   6   7 , Ping-Hsun Feng  8 , I-Wen Chen  8
Affiliations
Meta-Analysis

Diagnostic efficacy of serum presepsin for postoperative infectious complications: a meta-analysis

Chun-Ying Lu et al. Front Immunol. .

Abstract

Background: Postoperative infectious complications (PICs) are major concerns. Early and accurate diagnosis is critical for timely treatment and improved outcomes. Presepsin is an emerging biomarker for bacterial infections. However, its diagnostic efficacy for PICs across surgical specialties remains unclear.

Methods: In this study, a systematic search on MEDLINE, Embase, Google Scholar, and Cochrane Library was performed on September 30, 2023, to identify studies that evaluated presepsin for diagnosing PICs. PIC is defined as the development of surgical site infection or remote infection. Pooled sensitivity, specificity, and hierarchical summary receiver operating characteristic (HSROC) curves were calculated. The primary outcome was the assessment of the efficacy of presepsin for PIC diagnosis, and the secondary outcome was the investigation of the reliability of procalcitonin or C-reactive protein (CRP) in the diagnosis of PICs.

Results: This meta-analysis included eight studies (n = 984) and revealed that the pooled sensitivity and specificity of presepsin for PIC diagnosis were 76% (95% confidence interval [CI] 68%-82%) and 83% (95% CI 75%-89%), respectively. The HSROC curve yielded an area under the curve (AUC) of 0.77 (95% CI 0.73-0.81). Analysis of six studies on procalcitonin showed a combined sensitivity of 78% and specificity of 77%, with an AUC of 0.83 derived from the HSROC. Meanwhile, data from five studies on CRP indicated pooled sensitivity of 84% and specificity of 79%, with the HSROC curve yielding an AUC of 0.89.

Conclusion: Presepsin exhibits moderate diagnostic accuracy for PIC across surgical disciplines. Based on the HSROC-derived AUC, CRP has the highest diagnostic efficacy for PICs, followed by procalcitonin and presepsin. Nonetheless, presepsin demonstrated greater specificity than the other biomarkers. Further study is warranted to validate the utility of and optimize the cutoff values for presepsin.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023468358.

Keywords: C-reactive protein; infectious complications; meta-analysis; postoperative; presepsin; procalcitonin.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of study selection.
Figure 2
Figure 2
Summary of risk of bias for the included studies.
Figure 3
Figure 3
Forest plot showing the pooled sensitivity and specificity of presepsin for the diagnosis of postoperative infectious complications (PICs).
Figure 4
Figure 4
Hierarchical summary receiver operating characteristic curve of presepsin for the diagnosis of postoperative infectious complications (PICs).
Figure 5
Figure 5
Forest plot showing the pooled sensitivity and specificity of procalcitonin for the diagnosis of postoperative infectious complications (PICs).
Figure 6
Figure 6
Hierarchical summary receiver operating characteristic curve of procalcitonin for the diagnosis of postoperative infectious complications (PICs).
Figure 7
Figure 7
Forest plot showing the pooled sensitivity and specificity of C-reactive protein (CRP) for the diagnosis of postoperative infectious complications (PICs).
Figure 8
Figure 8
Hierarchical summary receiver operating characteristic curve of C-reactive protein (CRP) for the diagnosis of postoperative infectious complications (PICs).
Figure 9
Figure 9
Deeks’ funnel-plot asymmetry test for (A) presepsin, (B) procalcitonin, and (C) C-reactive protein (CRP). The three biomarkers have low risks of publication bias.
Figure 10
Figure 10
Fagan diagrams for the diagnosis of PICs: (A) presepsin, (B) procalcitonin, and (C) C-reactive protein (CRP).
See this image and copyright information in PMC

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