Prognostic value of presepsin in adult patients with sepsis: Systematic review and meta-analysis

Objective Presepsin is a novel biomarker to diagnose sepsis but its prognostic value has not been comprehensively reviewed. We conducted this meta-analysis to evaluate the mortality prediction value of presepsin in sepsis. Methods We searched comprehensive electronic databases from PubMed, EMBASE, and Cochrane Library through September 2017 using the key words of ('presepsin' or 'sCD14-ST' or 'soluble CD14 subtype') and ('sepsis' or 'septic shock') and (' p prognosis' or 'prognostic value' or 'prognostic biomarker' or 'mortality'). We extracted the presepsin levels in survivors and non-survivors from each individual study and evaluated the standardized mean difference (SMD) using a web-based meta-analysis with the R statistical analysis program. Results A total of 10 studies and 1617 patients were included. Presepsin levels in the first sampling (within 24 hours) were significantly lower among survivors as compared with non-survivors: the pooled SMD between survivors and non-survivors was 0.92 (95% CI: 0.62-1.22) in the random effects model (I-2 = 79%, P<0.01). In subgroups, divided by the sepsis severity or study site, pooled SMD was consistently noting higher presepsin levels in non-survivals (P< 0.05). Conclusion This meta-analysis demonstrates some mortality prediction value in presepsin in patients with sepsis. Further studies are needed to define the optimal cut-off point to predict mortality in sepsis.