中国普外基础与临床杂志

中国普外基础与临床杂志

Presepsin 诊断脓毒症价值的 meta 分析

查看全文

目的 系统评价 Presepsin 诊断脓毒症的价值。 方法 计算机检索 PubMed、The Cochrane Library(2017 年第 6 期)、EMbase、中国知网(CNKI)、中国生物医学文献数据库(CBM)、维普数据库(VIP)和万方数据库,收集有关 Presepsin 诊断脓毒症的诊断性试验,检索时限均为建库至 2017 年 6 月。由 2 位研究者独立筛选文献及提取数据,并采用 QUADAS-2 工具评价纳入研究的偏倚风险后,采用 RevMan 5.3 和 Meta-Disc 1.4 软件进行 meta 分析。计算指标包括合并敏感度(Sen合并)、合并特异度(Spe合并)、合并阳性似然比(LR+合并)、合并阴性似然比(LR-合并)、合并诊断比值比(DOR合并)及汇总受试者工作特征曲线(SROC)下面积(AUC)。 结果 最终纳入 23 篇文献,共计 2 925 例脓毒症患者和 1 852 例非脓毒症对照。meta 分析结果显示:Presepsin 诊断脓毒症的 Sen合并=0.8〔95% CI 为(0.78,0.81),P<0.000 1〕,Spe合并=0.83〔95% CI 为(0.81,0. 84),P<0.000 1〕,LR+合并=4.78〔95% CI 为(3.62,6.31),P<0.000 1〕,LR-合并=0.22〔95% CI 为(0.18,0.27),P<0.000 1〕,DOR合并=23.64〔95% CI 为(16,34.92),P<0.000 1〕,AUC=0.91〔95% CI 为(0.89,0.94),P<0.001〕。亚组分析结果显示:对于高加索人群,Sen合并=0.83〔95% CI 为(0.8,0.86),P=0.000 1〕,Spe合并=0.79〔95% CI 为(0.76,0.82),P<0.000 1〕,LR+合并=4.38〔95% CI 为(2.4,8.02),P<0.000 1〕,LR-合并=0.23〔95%CI(0.16,0.31),P=0.007 8〕,DOR合并=21.09〔95% CI 为(8.82,50.41),P<0.000 1〕,AUC=0.91〔95% CI 为(0.87,0.92),P<0.001〕;对于亚洲人群,Sen合并=0.79〔95% CI 为(0.77,0.8),P<0.000 1〕,Spe合并=0.85〔95% CI 为(0.83,0.87),P<0.000 1〕,LR+合并= 4.74〔95% CI 为(3.82,5.89),P=0.011 1〕,LR-合并=0.22〔95% CI 为(0.17,0.28),P<0.000 1〕,DOR合并=24.95〔95% CI 为(16.07,38.74),P<0.000 1〕,AUC=0.92〔95% CI 为(0.90,0.95),P=0.001〕。Presepsin 在两种人群间的诊断效能的差异没有统计学意义(Z=0.41,P>0.05)。 结论 当前证据显示,Presepsin 对脓毒症的早期诊断具有较高的临床价值。

Objective To systematically review the diagnostic value of Presepsin for sepsis. Methods Literatures were searched from PubMed, The Cochrane Library (Issue 6, 2017), EMbase, CNKI, CBM, VIP and WanFang database, and the time was from inception to June 2017, to collect diagnostic studies about Presepsin for sepsis. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies by QUADAS-2 tool. Then meta-analysis was performed by using RevMan 5.3 and Meta-Disc 1.4 software. Pooled sensitivity (Sen), specificity (Spe), positive likelihood ratio (LR+), negative likelihood ratio (LR-), diagnostic odds ratio (DOR), and area under the curve (AUC) of summary receiver operating characteristic curve (SROC) were calculated to assess the diagnostic value of individual diagnostic tests. Results A total of 23 studies with 2 925 sepsis patients and 1 852 controls were finally included. The results of meta-analysis showed that the pooled Sen, Spe, LR+, LR-, DOR, and AUC were 0.8〔95% CI was (0.78, 0.81), P<0.000 1〕, 0.83〔95%CI was (0.81, 0. 84), P<0.000 1〕, 4.78〔95%CI was (3.62, 6.31), P<0.000 1〕, 0.22〔95%CI was (0.18, 0.27), P<0.000 1〕, and 23.64〔95%CI was (16, 34.92), P<0.000 1〕, and 0.91〔95%CI was (0.89, 0.94), P<0.001〕. Subgroup analysis showed that the pooled Sen, Spe, LR+, LR-, DOR and, AUC of SROC in caucasian were 0.83〔95% CI was (0.8, 0.86), P=0.000 1〕, 0.79〔95% CI was (0.76, 0.82), P<0.000 1〕, 4.38〔95%CI was (2.4, 8.02), P<0.000 1〕, 0.23〔95%CI was (0.16, 0.31), P=0.007 8〕, 21.09〔95% CI was (8.82, 50.41), P<0.000 1〕, 0.91〔95%CI was (0.87, 0.92), P<0.001〕respectively, and in Asian were 0.79〔95% CI was (0.77, 0.80), P<0.000 1〕, 0.85〔95%CI was (0.83, 0.87), P<0.000 1〕, 4.74〔95%CI was (3.82, 5.89), P=0.011 1〕, 0.22〔95% CI was (0.17, 0.28), P<0.000 1〕, 〔95%CI was (16.07, 38.74), P<0.000 1〕, and 0.92〔95%CI was (0.90, 0.95), P=0.001〕respectively, there was no significant difference between caucasian and Asian in diagnostic accuracy of Presepsin (Z=0.41, P>0.05). Conclusions Current evidence indicates that Presepsin has great early diagnostic value for sepsis.

关键词: 脓毒症; 可溶性白细胞分化抗原 14 亚型; 诊断性试验; meta 分析

Key words: sepsis; Presepsin; diagnostic test; meta-analysis

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Zou Q, Wen W, Zhang XC. Presepsin as a novel sepsis biomarker. World J Emerg Med, 2014, 5(1): 16-19.
2. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med, 2013, 39(2): 165-228.
3. 金腊梅, 蒋明勇, 韦国华. Presepsin 对急诊患者脓毒症的诊断价值. 医学理论与实践, 2016, 29(3): 290-291.
4. Venkataraman R, Kellum JA. Sepsis: update in the management. Adv Chronic Kidney Dis, 2013, 20(1): 6-13.
5. Lee SH, Chan RC, Wu JY, et al. Diagnostic value of procalcitonin for bacterial infection in elderly patients-a systemic review and meta-analysis. Int J Clin Pract, 2013, 67(12): 1350-1357.
6. Mussap M, Noto A, Fravega M, et al. Soluble CD14 subtype presepsin (sCD14-ST) and lipopolysaccharide binding protein (LBP) in neonatal sepsis: new clinical and analytical perspectives for two old biomarkers. J Matern Fetal Neonatal Med, 2011, 24 Suppl 2: 12-14.
7. Yaegashi Y, Shirakawa K, Sato N, et al. Evaluation of a newly identified soluble CD14 subtype as a marker for sepsis. J Infect Chemother, 2005, 11(5): 234-238.
8. Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest, 1992, 101(6): 1644-1655.
9. 邬兰, 张永, 曾宪涛. QUADAS-2 在诊断准确性研究的质量评价工具中的应用. 湖北医药学院学报, 2013, 32(3): 201-208.
10. 张俊, 徐志伟, 李克. 诊断性试验 Meta 分析的效应指标评价. 中国循证医学杂志, 2013, 13(7): 890-895.
11. 黄波. presepsin 联合降钙素原和 C 反应蛋白检测对脓毒症早期诊断及预后评估的价值. 泰山医学院学报, 2016, 37(3): 321-322.
12. 余建, 邵强, 王权, 等. 联合检测 presepsin、降钙素原和 C 反应蛋白对脓毒症早期诊断及预后评估的价值. 临床检验杂志, 2014, 32(3): 200-203.
13. 崔岩, 张新超, 银彩霞, 等. Presepsin(sCD14-ST)检测对脓毒症急诊患者的诊断意义和预后评估价值. 中华医院感染学杂志, 2017, 27(1): 75-78.
14. 苏明环, 寿松涛. 血 presepsin 对脓毒症诊断及病情判断的临床价值. 临床检验杂志, 2014, 32(2): 106-108.
15. 杨彪, 王瑶, 高婷, 等. 急性创伤患者监测可溶性白细胞分化抗原 14 亚型对脓毒症的鉴别诊断及预后评价. 医学研究杂志, 2016, 45(8): 129-133.
16. 高杨, 寿松涛. 急性创伤患者早期监测 Presepsin 的临床意义. 天津: 天津医科大学, 2014.
17. 杨爱龙, 陈曦, 高宏伟, 等. 脓毒症的诊断和预后评估中 presepsin 的临床价值. 中华检验医学杂志, 2015, 38(2): 124-127.
18. 孔金水, 刘子永, 黄波. 创伤性脓毒症患者血清 Presepsin 水平与疾病严重程度及预后的相关性研究. 中国医学创新, 2016, 13(4): 17-19.
19. Liu B, Chen YX, Yin Q, et al. Diagnostic value and prognostic evaluation of Presepsin for sepsis in an emergency department. Crit Care, 2013, 17(5): R244.
20. de Guadiana Romualdo LG, Torrella PE, Acebes SR, et al. Diagnostic accuracy of presepsin (sCD14-ST) as a biomarker of infection and sepsis in the emergency department. Clin Chim Acta, 2017, 464: 6-11.
21. Behnes M, Bertsch T, Lepiorz D, et al. Diagnostic and prognostic utility of soluble CD 14 subtype (presepsin) for severe sepsis and septic shock during the first week of intensive care treatment. Crit Care, 2014, 18(5): 507-532.
22. Klouche K, Cristol JP, Devin J, et al. Diagnostic and prognostic value of soluble CD14 subtype (Presepsin) for sepsis and community-acquired pneumonia in ICU patients. Ann Intensive Care, 2016, 6(1): 59.
23. Kweon OJ, Choi JH, Park SK, et al. Usefulness of presepsin (sCD14 subtype) measurements as a new marker for the diagnosis and prediction of disease severity of sepsis in the Korean population. J Crit Care, 2014, 29(6): 965-970.
24. Endo S, Suzuki Y, Takahashi G, et al. Usefulness of presepsin in the diagnosis of sepsis in a multicenter prospective study. J Infect Chemother, 2012, 18(6): 891-897.
25. Enguix-Armada A, Escobar-Conesa R, García-De La Torre A, et al. Usefulness of several biomarkers in the management of septic patients: C-reactive protein, procalcitonin, presepsin and mid-regional pro-adrenomedullin. Clin Chem Lab Med, 2016, 54(1): 163-168.
26. Carpio R, Zapata J, Spanuth E, et al. Utility of presepsin (sCD14-ST) as a diagnostic and prognostic marker of sepsis in the emergency department. Clin Chim Acta, 2015, 450: 169-175.
27. Vodnik T, Kaljevic G, Tadic T, et al. Presepsin (sCD14-ST) in preoperative diagnosis of abdominal sepsis. Clin Chem Lab Med, 2013, 51(10): 2053-2062.
28. Nakamura Y, Ishikura H, Nishida T, et al. Usefulness of presepsin in the diagnosis of sepsis in patients with or without acute kidney injury. BMC Anesthesiol, 2014, 14: 88.
29. Shozushima T, Takahashi G, Matsumoto N, et al. Usefulness of presepsin (sCD14-ST) measurements as a marker for the diagnosis and severity of sepsis that satisfied diagnostic criteria of systemic inflammatory response syndrome. J Infect Chemother, 2011, 17(6): 764-769.
30. Takahashi G, Shibata S, Ishikura H, et al. Presepsin in the prognosis of infectious diseases and diagnosis of infectious disseminated intravascular coagulation: a prospective, multicentre, observational study. Eur J Anaesthesiol, 2015, 32(3): 199-206.
31. de Guadiana Romualdo LG, Torrella PE, González MV, et al. Diagnostic accuracy of presepsin (soluble CD14 subtype) for prediction of bacteremia in patients with systemic inflammatory response syndrome in the Emergency Department. Clin Biochem, 2014, 47(7-8): 505-508.
32. Sargentini V, Ceccarelli G, D’Alessandro M, et al. Presepsin as a potential marker for bacterial infection relapse in critical care patients. A preliminary study. Clin Chem Lab Med, 2015, 53(4): 567-573.
33. 韦国华, 蒋明勇, 金腊梅. Presepsin 对脓毒症诊断价值的 Meta 分析. 中国循证医学杂志, 2016, 16(3): 286-291.
34. Wu J, Hu L, Zhang G, et al. Accuracy of Presepsin in sepsis diagnosis: a systematic review and meta-analysis. PLoS One, 2015, 10(7): e0133057.
35. Liu Y, Hou JH, Li Q, et al. Biomarkers for diagnosis of sepsis in patients with systemic inflammatory response syndrome: a systematic review and meta-analysis. Springerplus, 2016, 5(1): 2091-3000.
36. Zhang J, Hu ZD, Song J, et al. Diagnostic value of Presepsin for sepsis: a systematic review and meta-analysis. Medicine (Baltimore), 2015, 94(47): e2158-e2165.
37. Tong X, Cao Y, Yu M, et al. Presepsin as a diagnostic marker for sepsis: evidence from a bivariate meta-analysis. Ther Clin Risk Manag, 2015, 11: 1027-1033.
38. Zhang X, Liu D, Liu YN, et al. The accuracy of presepsin (sCD14-ST) for the diagnosis of sepsis in adults: a meta-analysis. Crit Care, 2015, 19: 323-333.
39. Zheng Z, Jiang L, Ye L, et al. The accuracy of presepsin for the diagnosis of sepsis from SIRS: a systematic review and meta-analysis. Ann Intensive Care, 2015, 5(1): 48-60.
40. 张天嵩, 钟文昭, 李博. 诊断性试验的 Meta 分析//张天嵩, 徐国增, 熊茜. 实用循证医学方法学. 第 2 版. 长沙: 中南大学出版社, 2014: 417-427.
41. 廖娟, 林礼兴, 李扬宇, 等. sCD14-ST 在脓毒血症早期诊断中的应用. 检验医学, 2016, 31(7): 562-566.
42. Christ-Crain M, Müller B. Procalcitonin in bacterial infections-hype, hope, more or less? Swiss Med Wkly, 2005, 135(31-32): 451-460.
43. Becker KL, Snider R, Nylen ES. Procalcitonin assay in systemic inflammation, infection, and sepsis: clinical utility and limitations. Crit Care Med, 2008, 36(3): 941-952.
44. Okamura Y, Yokoi H. Development of a point-of-care assay system for measurement of presepsin (sCD14-ST). Clin Chim Acta, 2011, 412(23-24): 2157-2161.
45. Masson S, Caironi P, Spanuth E, et al. Presepsin (soluble CD14 subtype) and procalcitonin levels for mortality prediction in sepsis: data from the Albumin Italian Outcome Sepsis trial. Crit Care, 2014, 18(1): R6-R10.
46. Endo S, Suzuki Y, Takahashi G, et al. Presepsin as a powerful monitoring tool for the prognosis and treatment of sepsis: a multicenter prospective study. J Infect Chemother, 2014, 20(1): 30-34.
47. Masson S, Caironi P, Fanizza C, et al. Erratum to: circulating presepsin (soluble CD14 subtype) as a marker of host response in patients with severe sepsis or septic shock: data from the multicenter, randomized ALBIOS trial. Intensive Care Med, 2015, 41(9): 1736.
48. Palmiere C, Mussap M, Bardy D, et al. Diagnostic value of soluble CD14 subtype (sCD14-ST) presepsin for the postmortem diagnosis of sepsis-related fatalities. Int J Legal Med, 2013, 127(4): 799-808.
49. 邵珍珍, 李泉. CD14 在脓毒症中的最新进展. 同济大学学报 (医学版), 2016, 37(6): 136-140.