| Background and objective:Sepsis is one of the most common diseases in the world,with high morbidity and mortality,making it a serious threat to human health and a huge burden on economic development.The diagnosis of sepsis mainly depends on clinical diagnostic criteria and blood culture results,but the early clinical manifestations of sepsis are nonspecific,and the diagnosis of sepsis by blood culture takes a long time and has a high false negative rate,which lead many patients to miss the opportunity of early treatment and greatly reduces the survival rate of patients.Therefore,early diagnosis and precise treatment are very important for patients with sepsis.The value of infectious biomarkers in the diagnosis of sepsis has become a research hotspot.There have been many studies on the diagnostic value of PCT and IL-6 in sepsis at home and abroad,of which PCT is recommended as an expert consensus for early diagnosis of sepsis.In recent years,studies have found that neutrophil CD64 may be an emerging biomarker for the diagnosis of sepsis,but the results of various clinical studies are inconsistent.There is a lack of studies comparing traditional and emerging biomarkers for the diagnostic value of sepsis.The aim of the study is to integrate data by using meta-analysis methods to evaluate the accuracy of neutrophil CD64,PCT and IL-6 in the diagnosis of sepsis.Method:The databases of pubmed,web of science,medline,cochrane library,CNKI,CBM,Wanfang and Vip were searched electronically to collect the published studies on the diagnosis of sepsis by neutrophil CD64,PCT and IL-6 since the establishment of the database.The languages were limited to Chinese and English.We searched for subject terms and free words,and relevant references were retrieved.The literatures were screened strictly according to inclusion and exclusion criteria and literaturequality.By using the Stata SE 15.0 software,forest plots and SROC curves were drawn,the pooled sensitivity(SEN),specificity(SPE),positive likelihood-hood ratio(PLR),negative likelihood ratio(NLR),diagnostic odds ratio(DOR)and area under the SROC curve(AUC)were calculated.Heterogeneity between studies was assessed,and meta-regression,sensitivity analysis,and subgroup analysis were used to explore heterogeneity sources.Deek’s funnel plots were drawn to assess publication bias,and Fagan’s nomograms were used to evaluate the clinical efficacy of biomarkers.Z-test was performed on the AUC values of the three biomarkers and the corresponding Q index to compare their diagnostic value for sepsis.Results:1.Eventually,20 literatures of diagnostic value of neutrophil CD64 in sepsis were used for this meta-analysis.The pooled SEN of neutrophil CD64 for the diagnosis of sepsis was 0.88(95% CI:0.81,0.92),the SPE was 0.88(95% CI:0.83,0.91),the PLR was 7.2(95% CI:5.0,10.3),and the NLR was 0.14(95% CI:0.09,0.22).The pooled DOR was 51(95% CI:25,105),and the AUC value was 0.94(95% CI:0.91,0.96).2.Eventually,39 literatures of diagnostic value of procalcitonin in sepsis were used for this meta-analysis.The pooled SEN of procalcitonin for the diagnosis of sepsis was 0.82(95% CI:0.78,0.85),the SPE was 0.78(95% CI:0.74,0.82),the PLR was 3.7(95% CI:3.1,4.5),and the NLR was 0.23(95% CI: 0.19,0.29).The pooled DOR was 16(95% CI:11,23),and the AUC value was 0.87(95%CI:0.83,0.89).Subgroup analysis found that the AUC for PCT diagnosis of ICU sepsis was0.86(95% CI:0.83,0.89),and the AUC for PCT diagnosis of non-ICU sepsis was 0.82(95% CI:0.78,0.85).3.Eventually,15 literatures of diagnostic value of interleukin-6 in sepsis were used for this meta-analysis.The pooled SEN of interleukin-6 for the diagnosis of sepsis was was 0.72(95% CI: 0.65,0.78),the SPE was 0.70(95% CI: 0.62,0.76),the PLR was 2.4(95% CI: 1.9,3.0),and the NLR was 0.40(95% CI: 0.32,0.51).The pooled DOR was 6(95% CI: 4,9),and the AUC value of 0.77(95% CI: 0.73,0.80).4.The AUC values and the corresponding Q index of the three biomarkers weretested by Z test.The results showed that the pairwise comparisons of the three biomarkers were statistically significant(P<0.05).Conclusion:1.Using meta analysis to explore the diagnostic value of neutrophil CD64、PCT and IL-6 in sepsis,all of which were of certain value in the early diagnosis of sepsis,providing a new idea for the early diagnosis of sepsis.2.Compared with the three biomarkers,neutrophil CD64 has the highest diagnostic value for sepsis,followed by PCT,and the diagnostic value of IL-6 for sepsis is weaker than the two former.3.In the diagnosis of sepsis,the diagnostic value of PCT in severe patients is better than that in non-severe patients. |
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