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 (‘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.