Basal procalcitonin, C-reactive protein, interleukin-6, and presepsin for prediction of mortality in critically ill septic patients: a systematic review and meta-analysis.

Autor: Molano-Franco D; Hospital San José, Fundación Universitaria de Ciencias de la Salud (FUCS), CIMCA Research Group, Bogotá, Colombia., Arevalo-Rodriguez I; Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain. inarev7@yahoo.com., Muriel A; Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.; Nursing and Physiotherapy Department, University of Alcala, Madrid, Spain., Del Campo-Albendea L; Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain., Fernández-García S; WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK., Alvarez-Méndez A; Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain., Simancas-Racines D; Centro de investigación en Salud Pública y Epidemiología Clínica (CISPEC) Facultad de Ciencias de la Salud 'Eugenio Espejo', Universidad UTE, Quito, Ecuador., Viteri A; Centro de investigación en Salud Pública y Epidemiología Clínica (CISPEC) Facultad de Ciencias de la Salud 'Eugenio Espejo', Universidad UTE, Quito, Ecuador., Sanchez G; Hospital Universitario Mayor-Méderi; Universidad del Rosario, Bogota, Colombia., Fernandez-Felix B; Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain., Lopez-Alcalde J; Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.; Universidad Francisco de Vitoria, Pozuelo de Alarcon, Spain.; Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland., Solà I; Iberoamerican Cochrane Centre, IIB SANT PAU, CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain., Osorio D; Health Services Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain., Khan KS; Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, CIBER of Epidemiology and Public Health (CIBERESP), Granada, Spain., Nuvials X; Critical Care Department, Vall d'Hebron University Hospital, Shock Organ Dysfunction and Resuscitation Research Group (SODIR), Vall d'Hebron Research Institute (VHIR), Barcelona, Spain., Ferrer R; Critical Care Department, Vall d'Hebron University Hospital, Shock Organ Dysfunction and Resuscitation Research Group (SODIR), Vall d'Hebron Research Institute (VHIR), Barcelona, Spain., Zamora J; Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
Jazyk: angličtina
Zdroj: Diagnostic and prognostic research [Diagn Progn Res] 2023 Aug 03; Vol. 7 (1), pp. 15. Date of Electronic Publication: 2023 Aug 03.
DOI: 10.1186/s41512-023-00152-2
Abstrakt: Background: Numerous biomarkers have been proposed for diagnosis, therapeutic, and prognosis in sepsis. Previous evaluations of the value of biomarkers for predicting mortality due to this life-threatening condition fail to address the complexity of this condition and the risk of bias associated with prognostic studies. We evaluate the predictive performance of four of these biomarkers in the prognosis of mortality through a methodologically sound evaluation.
Methods: We conducted a systematic review a systematic review and meta-analysis to determine, in critically ill adults with sepsis, whether procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL-6), and presepsin (sCD14) are independent prognostic factors for mortality. We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials up to March 2023. Only Phase-2 confirmatory prognostic factor studies among critically ill septic adults were included. Random effects meta-analyses pooled the prognostic association estimates.
Results: We included 60 studies (15,681 patients) with 99 biomarker assessments. Quality of the statistical analysis and reporting domains using the QUIPS tool showed high risk of bias in > 60% assessments. The biomarker measurement as a continuous variable in models adjusted by key covariates (age and severity score) for predicting mortality at 28-30 days showed a null or near to null association for basal PCT (pooled OR = 0.99, 95% CI = 0.99-1.003), CRP (OR = 1.01, 95% CI = 0.87 to 1.17), and IL-6 (OR = 1.02, 95% CI = 1.01-1.03) and sCD14 (pooled HR = 1.003, 95% CI = 1.000 to 1.006). Additional meta-analyses accounting for other prognostic covariates had similarly null findings.
Conclusion: Baseline, isolated measurement of PCT, CRP, IL-6, and sCD14 has not been shown to help predict mortality in critically ill patients with sepsis. The role of these biomarkers should be evaluated in new studies where the patient selection would be standardized and the measurement of biomarker results.
Trial Registration: PROSPERO (CRD42019128790).
(© 2023. BioMed Central Ltd., part of Springer Nature.)
Databáze: MEDLINE
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