Diagnostic Value Of SCD14-ST For Adult Sepsis:A Meta-analysis

Objective: Sepsis refers to life-threatening organ dysfunction caused by a dysregulated host response to an infection.Severe sepsis can lead tomultiple organ dysfunction(MOF),which is one of the most frequent causes of death in patients within intensive care unit.Early diagnosis and timely treatment are the keys to improve the outcome of treatment and reduce the mortality of sepsis patients.Biomarkers play an important role in the early diagnosis of sepsis.Because the changes of routine laboratory tests such as blood routine and biomarkers such as C-reactive protein(CRP)and procalcitonin(PCT)are non-specific in the early stage of sepsis,the early diagnosis of sepsis has always been a difficult problem for clinicians.Soluble leukocyte differentiation antigen 14 subtypes(soluble CD14 subtype,sCD14-ST)is a new biomarker found in recently for the early diagnosis of sepsis.However,its diagnostic value is still lack of systematic evaluation.Therefore,this study aimed to evaluate the value of sCD14-ST in the early diagnosis of adult sepsis through the meta-analysis system.Methods: A search in database of CNKI,Wanfang,PubMed,Embase and Cochrane Library(from inception to March 2018)was performed to collect diagnostic tests related to sCD14-ST for sepsis.According to the inclusion criteriaofdiagnostic tests,two reviewers independently screened literatures and extracted data.The bias risk of the included studies was evaluated by using the QUADAS-2 tool.Then,meta-analysis was performed by using MetaDisc1.4 and RevMan5.3 software.The calculated parameters included sensitivity(Sen),specificity(Spe),positive likelihood ratio(LR+),negative likelihood ratio(LR-),diagnostic odds ratio(DOR)and area under the curve(AUC)of summary receiver operating characteristic curve(SROC).Results: A total of 862 relevant literatures were obtained in the preliminary examination.10 articles,including 2 Chinese articles and 8 English articles,were finally included,with total 2090 patients.The results of meta-analysis showed that the pooled Sen,pooled Spe,pooled LR+,pooled LR-,pooled DOR and pooled AUC was 0.81[95%CI(0.79,0.83),P<0.001],0.80 [95%CI(0.78,0.81),P<0.001],4.38 [95%CI(2.88,6.12),P<0.001],0.25 [95%CI(0.18,0.35),P<0.001],25.69 [95%CI(11.41,40.27),P<0.001],0.91 [95%CI(0.89,0.94),P<0.001],respectively.Significant heterogeneity among studies was observed.Geographic factors,age of patients,and sepsis severity are the causes of heterogeneity.Conclusions:1.The meta-analysis of sCD14-ST shows that it has a high clinical value in the early diagnosis of adult sepsis.2.sCD14-ST also shows positive correlation in risk assessment,prognosis judgment and antibiotic use guidance in sepsis patients.Its exact clinical significance needs to be studied in large-scale clinical studies.3.The optimal threshold for sCD14-ST diagnosis of sepsis has not been determined,which is the limitation of our research.4.The restrictions of the current research,such as low numbers of studies and the different inclusion and exclusion criteria used in each study,affects the reliability of the final conclusions.Futurelarge-scale and high-quality diagnostic experimental studies are required to verify the results.