(280) Comparison of presepsin and interleukin 6 for the diagnosis of neonatal sepsis: a systematic review and meta-analysis

Publication Number: 939

Background: Despite of immense advances in the health care system, sepsis remains as one of the prime causes of mortality among neonates. The diagnosis of neonatal sepsis is strenuous because of its unspecific sign and symptoms. Therefore, the need of a reliable biomarker is the need of the hour.

Objectives: The main aim of the study was to design a systemic review and metanalysis, comparing presepsin and interleukin 6 diagnostic accuracy, for the rapid diagnosis of neonatal sepsis.

Methods: PubMed, CINAHL, EMBASE and Scopus databases were explored for the last ten years for evaluating the diagnostic accuracy of presepsin and interleukin 6 in neonatal sepsis. PRISMA guidelines were followed for the article screening procedure, whereas data extraction was performed based on Preferred Reporting Items for Systematic review and Meta-analysis of Diagnostic test Accuracy Studies (PRISMA- DTA) checklist. Meanwhile, QUADAS-2 tool was applied to gauge the risk of bias and applicability concerns of included articles. Spearmen correlation statistics was performed to evaluate the heterogenicity due to threshold effect, whereas the heterogeneity due to non-threshold effect was evaluated by bivariate regression model using Meta-DTA software. Pooled sensitivity, specificity, DOR, PLR and NLR were the primary outcome of the study, whereas HS-ROC was performed to evaluate the diagnostic ability of both the markers.

Results: An aggregate of four articles were comprehended after the whole screening process. Greater number of studies embodied (3 studies) were of prospective study design while alone one study was of cross-sectional type. Bigger half of the incorporated studies (2 studies) had diagnosed neonatal sepsis as general while, the remaining two studies had prorated it into late and early onset neonatal sepsis individually. In terms of risk of bias, majority of the article i.e., 3 articles had low risk of bias, while one has high. The individual spearmen correlation coefficient and p value for presepsin and Il-6 were -0.44; p=0.600 and 0.600; p=0.400 respectively. Presepsin had I2 value of 0% and 75.7% pertaining to sensitivity and specificity correspondingly while IL-6 had 72.2% and 92%, thus indicating towards heterogeneity by non- threshold effects. The combined sensitivity and specificity along with confidence interval of presepsin and IL-6 were 0.86 (0.81-0.90), 0.89(0.84- 0.92) and 0.88(0.82-0.93), 0.78 (0.70-0.84) respectively, while the AUC of HSROC was 0.939 and 0.910 respectively.

Conclusions: Output obtained from our studies concludes that presepsin can be considered as a better diagnostic marker than interleukin 6. However, extensive research is required to confirm these findings.