The accuracy of soluble urokinase-type plasminogen activator receptor for the diagnosis of neonatal sepsis: a meta-analysis

Abstract

BackgroundNeonatal sepsis is one of the major causes of morbidity and mortality in newborns. However, atypical clinical manifestations and symptoms make the early diagnosis of neonatal sepsis a challenge. Relatively high-serum soluble urokinase-type plasminogen activator receptor (suPAR) has been implicated as a diagnostic biomarker for adult sepsis. Therefore, the meta-analysis is intended to explore the diagnostic value of suPAR for neonatal sepsis.MethodsThe PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, China Biological Medicine Disk, and Wanfang databases were retrieved from inception to 31 December 2022 to collect diagnostic accuracy studies about suPAR for neonatal sepsis. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias in the included studies using the quality assessment of diagnostic accuracy studies-2 (QUADAS-2) tool. Then, a meta-analysis was performed using Stata 15.0 software.ResultsA total of six articles involving eight studies were included. The results of the meta-analysis showed that the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.89 [95%CI (0.83–0.93)], 0.94 [95%CI (0.77–0.98)], 14 [95%CI (3.5–55.2)], 0.12 [95%CI (0.08–0.18)], and 117 [95%CI (24–567)], respectively. The area under the curve (AUC) of summary receiver operator characteristic (SROC) curves was 0.92 [95%CI (0.90–0.94)]. Sensitivity analysis confirmed the stability of the results, and publication bias was not observed. Fagan’s nomogram results demonstrated the clinical availability of the findings.ConclusionCurrent evidence suggests that suPAR has potential diagnostic value for neonatal sepsis. Owing to the limited quality of the included studies, more high-quality studies are needed to verify the above conclusion.

Urokinase-Type Plasminogen Activator Receptor (uPAR) in Inflammation and Disease: A Unique Inflammatory Pathway Activator

“…This means that if the suPAR level is negative, the probability of neonatal sepsis is 12%, allowing confidence in ruling neonatal sepsis. Interestingly, in neonatal patients, and in concordance with the adult patients, the measured levels of suPAR on the first day helped in predicting mortality in late-onset neonatal sepsis [ 88 , 89 , 90 ]. Finally, suPAR is also useful as a prognostic biomarker in adult sepsis [ 91 ].…”

Biological markers of sepsis

“…SuPAR is used as a diagnostic biomarker for sepsis in adults and has a potential diagnostic value in neonatal sepsis [8]. Elevated suPAR is associated with mortality in patients with developed sepsis [69].…”

“…The incidence and mortality rates of sepsis are particu larly high in newborns. In this case, the problem of early diagnosis is practically unresolved, due to atypical clinical manifestations of neonatal sepsis [8] and the time-consuming nature of blood culture analysis for sepsis, namely inoculation for sterility testing. Thus, the identification of biomarkers for the early diagnosis of neonatal sepsis is a pressing issue [9].…”

Biomaterials for treating sepsis-induced thromboinflammation

“…Frontiers in Biomaterials Science frontiersin.org et al, Ma et al, 2023). Urokinase is not widely used as a thrombolytic due to its markedly reduced specificity for fibrin and increased bleeding risk in comparison to tPA (Adivitiya and Khasa, 2017;Kadir and Bayraktutan, 2020).…”