Presepsin found to be accurate biomarker of Early-Onset Sepsis: JAMA Pediatrics

Presepsin was an accurate biomarker of Early-Onset Sepsis (EOS), as suggested by a recent study published in JAMA Pediatrics.

Early-onset sepsis (EOS) is defined as blood or cerebrospinal fluid culture obtained during the first 72 hours of life that grows a pathogenic bacterial species.EOS diagnosis is a frequent challenge in the neonatal intensive care unit, as clinical signs are equivocal and the common markers of infection, such as C-reactive protein and procalcitonin, physiologically increase during the first 48 hours of life in response to noninfective stimuli.

Presepsin results from the cleavage of CD14 by circulating bacterial proteases during sepsis. Chiara Poggi et. al conducted a systematic review and meta analysis to assess presepsin accuracy for the diagnosis of EOS.

PubMed Medline, EMBASE, Web of Science, and Google Scholar were taken as data sources. No publication date restrictions were applied. The literature search was limited to the English language. Articles were checked for duplication.

Inclusion criteria were studies that (1) included term or preterm newborns (defined as newborns with gestational age 37 weeks or <37 weeks, respectively); (2) included a diagnosis of EOS, defined as culture-proven sepsis for primary analysis and as either clinical or culture-proven sepsis for secondary analysis; and (3) assessed presepsin values during the initial workup for suspected EOS.

Exclusion criteria were studies that (1) did not include EOS cases; (2) lacked data on presepsin sensitivity and/or specificity; and (3) were case reports, commentaries, or reviews. Two independent reviewers performed the study selection. DATA EXTRACTION AND SYNTHESIS Two independent reviewers performed data extraction and quality assessment. Quality assessment was performed using the Quality Assessment for Studies of Diagnostic Accuracy 2 tool, and data were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were pooled using a random-effects model.

The outcomes of interest for both the primary and secondary analyses were presepsin sensitivity, specificity, and diagnostic odds ratio for the diagnosis of EOS. A total of 12 studies of 245 (4.9%) met the inclusion criteria for the primary analysis. Twenty-three studies of 245 (9.4%) met the inclusion criteria for the secondary analysis.

The study authors found that:

● In the primary analysis, among 12 studies and 828 newborns of any gestational age, pooled sensitivity and specificity were 0.93 and 0.91, respectively; pooled diagnostic odds ratio was 131.69.

● Subgroup analysis showed that presepsin specificity was associated with the inclusion of only EOS or all neonatal sepsis.

● Presepsin accuracy was not associated with gestational age, measurement with chemiluminescence enzyme immunoassay or enzyme-linked immunosorbent assay testing, country where the study was performed, or risk of bias judgment.

● In the secondary analysis, among 23 studies and 1866 newborns, accuracy was significantly associated with only test type.

"Results of this systematic review and meta-analysis suggest that presepsin was an accurate biomarker of EOS. Clinical trials are warranted to assess its usefulness and safety to reduce early antibiotic exposure, particularly in preterm newborns," the authors concluded.