title: Accuracy of Presepsin in Sepsis Diagnosis: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  It's difficult to differentiate sepsis from non-sepsis, especially non-infectious SIRS, because no good standard exists for proof of infection. Soluble CD14 subtype (sCD14-ST), recently re-named presepsin, was identified as a new marker for the diagnosis of sepsis in several reports. However, the findings were based on the results of individual clinical trials, rather than a comprehensive and overall estimation. Thus, we conducted this systematic review and meta-analysis to estimate the pooled accuracy of presepsin in patients with sepsis suspect.
  
  
  METHODS
  A comprehensive electronic search was performed via internet retrieval system up to 15 December 2014. Methodological quality assessment was applied by using the QUADAS2 tool. The diagnostic value of presepsin in sepsis was evaluated by using the pooled estimate of sensitivity, specificity, likelihood ratio, and diagnostic odds ratio, as well as summary receiver operating characteristics curve.
  
  
  RESULTS
  Nine studies with 10 trials and 2159 cases were included in the study. Only two trials had low concerns regarding applicability, whereas all trials were deemed to be at high risk of bias. Heterogeneity existed in the non-threshold effect, but not in the threshold effect. The pooled sensitivity of presepsin for sepsis was 0.78 (0.76-0.80), pooled specificity was 0.83 (0.80-0.85), pooled positive likelihood ratio was 4.63 (3.27-6.55), pooled negative likelihood ratio was 0.22 (0.16-0.30), and pooled diagnostic odds ratio was 21.73 (12.81-36.86). The area under curve of summary receiver operating characteristics curve was 0.89 (95%CI: 0.84 to 0.94) and Q* index was 0.82 (95%CI: 0.77 to 0.87).
  
  
  CONCLUSIONS
  This meta-analysis demonstrates that presepsin had some superiority in the management of patients, and may be a helpful and valuable biomarker in early diagnosis of sepsis. However, presepsin showed a moderate diagnostic accuracy in differentiating sepsis from non-sepsis which prevented it from being recommended as a definitive test for diagnosing sepsis in isolation, but the results should be interpreted cautiously.
authors.affiliation: Nutritional Department, The Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China.
authors.forename: Jiayuan
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Zhanjiang, Guangdong, China.
authors.forename: Liren
authors.initials: L
authors.lastname: Hu
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Zhanjiang, Guangdong, China.
authors.forename: Gaohua
authors.initials: G
authors.lastname: Zhang
authors.affiliation: Department of Radiotherapy, The Seventh People's Hospital of Chengdu, The Oncology Hospital of Chengdu, Chengdu, Sichuan Province, China.
authors.forename: Fenping
authors.initials: F
authors.lastname: Wu
authors.affiliation: School of Public Health, Guangdong Medical College, Zhanjiang, Guangdong Province, China.
authors.forename: Taiping
authors.initials: T
authors.lastname: He
mesh_terms: D019540:Area Under Curve; D015415:Biomarkers / Q000032:analysis; D016208:Databases, Factual; D006801:Humans; D018950:Lipopolysaccharide Receptors / Q000032:analysis*; D016017:Odds Ratio; D010446:Peptide Fragments / Q000032:analysis*; D012372:ROC Curve; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis* / Q000378:metabolism
chemical_list: D015415:Biomarkers; D018950:Lipopolysaccharide Receptors; D010446:Peptide Fragments; C000594167:presepsin protein, human