Comparison of presepsin and Mid-regional pro-adrenomedullin in the diagnosis of sepsis or septic shock: a systematic review and meta-analysis

Abstract

Background The early diagnosis of sepsis is hampered by the lack of reliable laboratory measures. There is growing evidence that presepsin and Mid-regional pro-adrenomedullin (MR-proADM) are promising biomarkers in the diagnosis of sepsis. This study was conducted to evaluate and compare the diagnostic value of MR-proADM and presepsin in sepsis patients. Methods We searched Web of Science, PubMed, Embase, China national knowledge infrastructure, and Wanfang up to 22th July, 2022, for studies evaluating the diagnosis performance of presepsin and MR-proADM in adult sepsis patients. Risk of bias was assessed using quadas-2. Pooled sensitivity and specificity were calculated using bivariate meta-analysis. Meta-regression and subgroup analysis were used to find source of heterogeneity. Results A total of 40 studies were eventually selected for inclusion in this meta-analysis, including 33 for presepsin and seven for MR-proADM. Presepsin had a sensitivity of 0.86 (0.82–0.90), a specificity of 0.79 (0.71–0.85), and an AUC of 0.90 (0.87–0.92). The sensitivity of MR-proADM was 0.84 (0.78–0.88), specificity was 0.86 (0.79–0.91), and AUC was 0.91 (0.88–0.93). The profile of control group, population, and standard reference may be potential sources of heterogeneity. Conclusions This meta-analysis demonstrated that presepsin and MR-proADM exhibited high accuracy (AUC ≥ 0.90) in the diagnosis of sepsis in adults, with MR-proADM showing significantly higher accuracy than presepsin.

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

“…These findings are consistent with the results of a recent meta-analysis centered on the diagnostic capability of presepsin for sepsis, wherein the cutoff values spanned from 89.26 to 1,315 pg/mL. The extensive variation in these cutoff values could be attributed to disparities in disease severity, study methodologies, and clinical settings ( 13 ). To determine a clinically relevant cutoff value, further research targeting specific patient subgroups and the efficacy of presepsin is essential.…”

“…While previous studies reported elevated presepsin levels in patients with viral meningitis and fungemia ( 37 , 38 ), the diagnostic accuracy for sepsis related to parasites, viruses, and fungi remains to be firmly established. During the onset of sepsis, the levels of presepsin elevate early ( 39 , 40 ), making it a valuable indicator for detecting and predicting the course of sepsis ( 13 ). While surgical trauma has not been associated with elevated presepsin levels ( 1 , 15 , 22 ), the utility of presepsin in the diagnosis of PICs remain unclear due to the lack of consolidated evidence.…”

“…The AUC from the HSROC curve was 0.77, indicating its potential diagnostic accuracy. A recent meta-analysis of 33 studies revealed that presepsin, in the diagnosis of sepsis, exhibited pooled sensitivity of 0.86, pooled specificity of 0.79, and an AUC of 0.90 ( 13 ). It seems that presepsin can be considered as a useful biomarker for both PICs and sepsis.…”

“…Presepsin (soluble CD14 subtype) is a 13-kDa truncated fragment derived from the CD14 membrane protein and is released into circulation during monocyte activation upon recognition of lipopolysaccharides from bacterial cell walls ( 12 ). Several studies have recently reported that presepsin may be used to predict sepsis or PICs ( 1 , 13 – 16 ). Compared with other conventional biomarkers, presepsin has distinct advantages, including an early rise of infection onset within 2 h and rapid normalization after recovery ( 17 ).…”

PAMPs and DAMPs in Sepsis: A Review of Their Molecular Features and Potential Clinical Implications

“…The area under the curve (AUC) was 0.89 (95% CI: 0.86-0.92) [123]. Presepsin and MR-proADM have shown good values of accuracy in another meta-analysis by Liang et al [124].…”