title: Diagnostic Accuracy of Lipopolysaccharide-Binding Protein as Biomarker for Sepsis in Adult Patients: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Lipopolysaccharide-binding protein (LBP) is widely reported as a biomarker to differentiate infected from non-infected patients. The diagnostic use of LBP for sepsis remains a matter of debate. We aimed to perform a systematic review and meta-analysis to assess the diagnostic accuracy of serum LBP for sepsis in adult patients.
  
  
  METHODS
  We performed a systematic review and meta-analysis to assess the accuracy of LBP for sepsis diagnosis. A systematic search in PubMed and EMBASE for studies that evaluated the diagnostic role of LBP for sepsis through December 2015 was conducted. We searched these databases for original, English language, research articles that studied the diagnostic accuracy between septic and non-septic adult patients. Sensitivity, specificity, and other measures of accuracy, such as diagnostic odds ratio (DOR) and area under the receiver operating characteristic curve (AUC) of LBP were pooled using the Hierarchical Summary Receiver Operating Characteristic (HSROC) method.
  
  
  RESULTS
  Our search returned 53 reports, of which 8 fulfilled the inclusion criteria, accounting for 1684 patients. The pooled sensitivity and specificity of LBP for diagnosis of sepsis by the HSROC method were 0.64 (95% CI: 0.56-0.72) and 0.63 (95% CI: 0.53-0.73), respectively. The value of the DOR was 3.0 (95% CI: 2.0-4.0) and the AUC was 0.68 (95% CI: 0.64-0.72). Meta-regression analysis revealed that cut-off values accounted for the heterogeneity of sensitivity and sample size (> = 150) accounted for the heterogeneity of specificity.
  
  
  CONCLUSIONS
  Based on the results of our meta-analysis, LBP had weak sensitivity and specificity in the detection of sepsis. LBP may not be practically recommended for clinical utilization as a single biomarker.
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.|Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan.|Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors.forename: Kuan-Fu
authors.initials: KF
authors.lastname: Chen
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: Chung-Hsien
authors.initials: CH
authors.lastname: Chaou
authors.affiliation: School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Jing-Yi
authors.initials: JY
authors.lastname: Jiang
authors.affiliation: School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Hsueh-Wen
authors.initials: HW
authors.lastname: Yu
authors.affiliation: School of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Meng
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors.forename: Wei-Chen
authors.initials: WC
authors.lastname: Tang
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors.forename: Chin-Chieh
authors.initials: CC
authors.lastname: Wu
mesh_terms: D000209:Acute-Phase Proteins / Q000378:metabolism*; D000328:Adult; D015415:Biomarkers / Q000378:metabolism*; D002352:Carrier Proteins / Q000378:metabolism*; D006801:Humans; D008562:Membrane Glycoproteins / Q000378:metabolism*; D011379:Prognosis; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis* / Q000378:metabolism*; D000099231:Lipopolysaccharide-Binding Protein
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D002352:Carrier Proteins; D008562:Membrane Glycoproteins; D000099231:Lipopolysaccharide-Binding Protein