Comparison of diagnostic accuracy in sepsis between presepsin, procalcitonin, and C-reactive protein: a systematic review and meta-analysis

Reason for choosing this article:

During my time in my Internal Med rotation, sepsis cases commonly popped up each time I would be in the ED. In internal med- and in pretty much every field- sepsis will always come up, making it extremely important to know how to recognize it quickly and treat patients adequately. PAs and providers must also be diligent in knowing how to distinguish SEPSIS from non-infectious SIRS, which is what this article talks about.

 Background:

• Sepsis is a life-threatening disease which must be treated with early IV fluid and abx, however it can be difficult to decide early on if this treatment is needed due to the existence of non-infectious SIRS
• Due to this issue, identifying a biomarker that can distinguish sepsis from non-infectious SIRS has become an important topic
• Currently, procalcitonin and CRP are the preferred biomarkers however they come with their own issues
• CRP levels increase in 4-6 hours and reaches peak in 48-72 hours after onset. PCT increases in 8-24 hours and reaches peak later than 24 hours. Therefore, both PCT and CRP might still not be reliable enough as early indicators for sepsis used in the clinical context
• using presepsin as a biomarker has become a topic of discussion because presepsin levels increase within 2 hours and reaches peak in 3 hours after infection, meaning that it might be a better biomarker for sepsis during the early stage of sepsis than in later stages
• This systematic review and meta-analysis was conducted to compare the diagnostic accuracy of presepsin with other biomarkers in diagnosing sepsis 

Method:

• Studies collected for research came from PubMed and EMBASE
• 18 studies fulfilled the eligibility criteria for this study and were included in the final meta-analyses (published between 2011-2017) with a total sample of 3,270 patients among all studies

Discussion:

• The results of the study suggested good overall diagnostic accuracy for presepsis according to the pooled sensitivity and specificity and AUC value
• There were several limitations in this analysis, mainly because there were significantly less studies focusing on the efficacy of presepsin compared to CRP and PCT
• Although CRP is commonly used as a biomarker, previous studies revealed that its diagnostic accuracy for sepsis is significantly lower than PCT
  • After comparing presepsin with CRP, the results supported that presepsin showed similar performance with CRP in sepsis diagnosis

Conclusion:

• Presepsin is a promising marker for diagnosis of sepsis as PCT or CRP BUT results should be interpreted cautiously since there are only a limited number of studies comparing these biomarkers
• Additionally, the article recommends to use a combination of biomarkers for diagnosing sepsis, rather than relying on a single test, as there would be less room for error- furthermore, re-evaluating and following up labs on a potential sepsis patient is the best way to ensure that the patient is receiving adequate treatment.