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©The Author(s) 2023.
World J Crit Care Med. Sep 9, 2023; 12(4): 188-203
Published online Sep 9, 2023. doi: 10.5492/wjccm.v12.i4.188
Published online Sep 9, 2023. doi: 10.5492/wjccm.v12.i4.188
Table 1 Biomarkers in sepsis
| Biomarker | Description |
| Procalcitonin | Precursor of hormone calcitonin secreted by C cells of thyroid gland |
| C-reactive protein | Acute phase protein secreted by hepatocytes in response to pathogen or tissue damage |
| IL6 | A cytokine, mainly produced by macrophages and lymphocytes in response to infection and it can affect the activation of B and T lymphocytes |
| suPAR | A protein derived from cleavage and release of cell membrane bound urokinase plasminogen activator receptor |
| sTREM1 | Mainly expressed on the surface of polymorphonuclear cells and mature monocytes |
| Presepsin (sCD14-ST) | sCD14 is cleaved by proteases during inflammation, to form an N terminal fragment-the sCD14 subtype (sCD14-ST) |
| Adrenomedullin | A 52 amino acid peptide initially isolated from phaeochromocytomas. It is secreted by mammalian tissues and endothelial cells in response to various stimuli such as hypoxia, angiotensin 2, inflammatory cytokine such as TNF-α, IL-1β, etc. |
| Mid regional Proadrenomedullin (MR-proADM) | A peptide secreted by multiple tissues in order to stabilize the microcirculation and protect against endothelial permeability |
Table 2 Biomarkers for diagnosis of sepsis
| Ref. | Study characteristics | Results and inference | ||||
| Study type | Patient characteristics | Variables | AUC/95%CI | Sensitivity/specificity/PPV/NPV | Inference | |
| Tan et al[5], 2019 | Meta-Analysis; 9 studies | Pooled data. Total: 1368 patients. Sepsis: 495. Non sepsis: 873 | CRP; PCT | 0.73 (95%CI: 0.69-0.77), 0.85 (95% CI: 0.82-0.88) | Sensitivity 0.80 (95%CI: 0.63-0.90); spec: 0.61 (95%CI: 0.50-0.72) DOR: 6.89 (95%CI: 3.86-12.31); sensitivity 0.80 (95%CI: 0.69-0.87); specificity: 0.77 (95%CI: 0.60-0.88) DOR: 12.50 (95%CI: 3.65-42.80) | Diagnosis accuracy and specificity of PCT are higher than those of CRP |
| Thomas-Rüddel et al[9], 2018 | Randomised control trial, Prospective, Secondary analysis | Gram negative vs Gram positive bacteremia and candidemia | PCT (Gram negative bacteremia) | 0.72 (95%CI: 0.71-0.74) | Value was 10 ng/mL sensitivity 69%, specificity 35% for Gram negative bacteraemia | Streptococci, E. coli and other Enterobacteriaceae detected from BC were associated with three times higher PCT values. Urogenital or abdominal foci of infection were associated with twofold increased PCT |
| Lai et al[7], 2020 | Meta-Analysis; 25 studies | GNBSI | CRP | 0.85 (0.81–0.87) | Sens: 0.75 (0.56–0.87); Spec: 0.80 (0.68–0.88) | PCT was helpful in recognizing GNBSI, but the test results should be interpreted carefully with knowledge of patients' medical condition and should not serve as the only criterion for GNBSI |
| PCT | 0.87 (0.84–0.90) | Sens: 0.80 (0.60–0.91); Spec: 0.82 (0.72–0.89) | ||||
| IL6 | 0.83 (0.80-0.86) | Sens: 0.76 (0.58–0.88); Spec: 0.79 (0.71-0.85) | ||||
| Zhao et al[29], 2014 | Prospective; Observational, single centre | Total: 652; Sepsis: 452; Non sepsis SIRS: 200 | PCT | 0.803 | Sens: 75.2%, Spec: 80.0%, PPV: 89.5%, NPV: 58.8% | Combination of PCT, IL6 and D-dimer enhances the diagnostic ability for sepsis and severe sepsis |
| IL6 | 0.770 | Sens: 81.0%, Spec: 61.0%, PPV: 82.4%, NPV: 58.7% | ||||
| D-Dimer | (0.737) | Sens: 79.9%, Spec: 59.0%, PPV: 81.5%, NPV: 56.5% | ||||
| PCT + IL6 + D-Dimer | 0.866 | Sens: 81.6%, Spec: 73.6%, PPV: 56.0%, NPV: 90.6% | ||||
| Kondo et al[14], 2019 | Meta-Analysis; 19 studies | Adult. Tot: 3012 | Presepsin | 0.87 | Sens: 0.84 (95% 0.80-0.88); Spec: 0.73 (0.61-0.82) | Diagnostic accuracy of procalcitonin and presepsin in detecting infection was similar |
| PCT | 0.84 | Sens: 0.80 (0.75-0.84); spec 0.75 (0.67-0.81) | ||||
| Kang et al[16], 2019 | Adult | Infected trauma: 89; Non infected trauma: 68; Healthy controls: 60 | Presepsin | 0.853 (0.784-0.922) | 321.5 pg/mL; Sens: 67.2%; Spec: 91.9; PPV: 87.5; NPV: 78.2; LR+: 4.89; LR-: 0.39 | Presepsin might be a superior biomarker for early differentiation of infection in trauma patients |
| PCT | 0.771 (0.682-0.859) | 0.923 ng/mL; Sens: 61.1%; Spec: 88.2%; PPV: 79.1; NPV: 74.7; LR+: 5.21; LR-: 0.47 | ||||
| Presepsin + ISS | 0.939 (0.9-0.977) | |||||
| Liu et al[15], 2013 | Prospective, adult consecutive, emergency department | Total: 859; Control: 100; SIRS: 372; Sepsis: 372; Severe sepsis: 210; Septic shock: 98 | Presepsin | 0.820 (0.784-0.856) | 317 pg/mL; Sens: 70.8%; Spec: 85.8%; PPV: 93.2%; NPV: 51.6%; LR+: 4.99; LR-: 0.34 | Presepsin is a valuable biomarker for early diagnosis of sepsis. trauma stress elevates PCT, CRP, and WBCs even in the absence of infection |
| PCT | 0.724 (0.680 to 0.769) | 0.25 ng/mL; Sens: 60%; Spec: 77.7%; PPV: 93.2%; NPV: 28.4%; LR+: 2.69; LR-: 0.51 | ||||
| Cong et al[20], 2021 | Meta-Analysis | Adult 20 studies | CD 64 | 0.94 (0.91-0.96) | Sens: 0.88 (0.81-0.92); Spec: 0.88 (0.83-0.91); LR+: 7.2; LR-: 0.14; DOR-51 (25-101) | Neutrophil CD64 test has a high sensitivity and specificity in adult sepsis patients, and was superior to the traditional biomarkers PCT and IL6 |
| PCT | 0.87 (0.83-0.89) | Sens: 0.82 (0.78-0.85); Spec-: 0.78 (0.74-0.82); LR+: 3.7; LR-: 0.23; DOR-16 (11-23) | ||||
| IL6 | 0.77 (0.73-0.80) | Sens: 0.72 (0.65-0.78); Spec: 0.70 (0.62-0.76); LR+: 2.4; LR-: 0.40; DOR-6 (4-9) | ||||
| Gámez-Díaz et al[25], 2011 | Prospective, cohort | Emergency, total 631 pts; based on expert consensus, Sepsis- 416 | nCD-64 | NA | Sens: 65.8% (95%CI: 61.1%-70.3%); Spec: 64.6% (95%CI: 57.8%-70.8%); LR+: 1.85 (95%CI: 1.52-2.26); LR-: 0.52 (95%CI: 0.44-0.62) | Patients suspected of having any infection in the ED, the accuracy of nCD64, sTREM1, and HMGB-1 was not significantly sensitive or specific for diagnosis of sepsis |
| HMGB-1 | Sens: 57.5% (95%CI: 52.7%-62.3%); Spec: 57.8% (95%CI: 51.1%-64.3%); LR+: 1.36 (95%CI: 1.14-1.63); LR-: 0.73 (95%CI: 0.62-0.86) | |||||
| s-TREM-1 | Sens: 60% (95%CI: 55.2%-64.7%). Spec: 59.2% (95%CI: 52.5%-65.6%). LR+: 1.47 (95%CI: 1.22-1.76). LR-: 0.67 (95%CI: 0.57-0.79) | |||||
| Yeh et al[19], 2019 | Metaanalysis. 14 studies | Adult, pooled data: Total: 2471; Control: 1167; Sepsis: 1304 | Neutrophilic CD 64 | 0.89 (0.87–0.92) | Sens: 0.87 (0.80-0.92); spec 0.89 (0.82-0.93) | Neutrophil CD64 levels are an excellent biomarker with moderate accuracy outperforming both CRP and PCT determinations |
| PCT | 0.84 (0.79–0.89) | Sens: 0.76 (0.61-0.86); spec 0.79 (0.70-0.86) | ||||
| CRP | 0.84 (0.80–0.88) | Sens: 0.83 (0.78-0.86); spec 0.71 (0.56-0.85) | ||||
| Dimoula et al[22], 2014 | Prospective observational study | 548 adult ICU patients. Sepsis: 103; Non sepsis: 445 | nCD64 | NR | 230 MFI. sens: 89% (81%-94%); spec: 87% (83%-90%). | Combining CRP and nCD64 expression, an abnormal result for both was associated with a 92% probability of sepsis, whereas sepsis was ruled out with a probability of 99% if both were normal. In nonseptic patients, an increase in nCD64 expression ≥ 40 MFI predicted ICU-acquired infection (n = 29) with a sensitivity of 88% and specificity of 65% |
| Wang et al[23], 2021 | Metaanalysis: 7 articles | Neonatal, paediatric and adults | IL27 | 0.88 (0.84-0.90) | Sens: 0.85 (95%CI: 0.72-0.93); Spec: 0.72 (95%CI: 0.42-0.90); DOR-15 (95%CI: 3-72) | IL27 is a reliable diagnostic biomarker for sepsis and should be evaluated with other clinical tests |
| Wong et al[24], 2013 | Prospective | Adults, infective (n = 145) and non-infective (n = 125) critically ill | IL27 | 0.68 (0.62-0.75) | IL27 inferior to PCT in sepsis diagnosis | |
| PCT | 0.84 (0.79-0.89) | |||||
| Uusitalo-Seppälä et al[27], 2012 | Prospective cohort | 525 adult patients in emergency. Severe sepsis: 49; Sepsis: 302; SIRS: 58. Sirs with no bacterial infection: 53. Bacterial infection no SIRS: 63 | PLA(2)GIIA | NA | OR: 1.48 (1.20-1.81, P < 0.001) | Differences in AUC between these parameters were not significant. On multivariate logistic regression analysis only PLA(2)GIIA could differentiate patients with severe sepsis from others (OR: 1.37, 95%CI: 1.05-1.78, P = 0.019 |
| BPI | OR: 2.66 (1.54-4.60, P = 0.001) | |||||
| CRP | OR: 1.35 (1.02-1.77, P = 0.036) | |||||
| WBC | OR: 2.81 (1.48-5.34, P = 0.002) | |||||
| Aksaray et al[26], 2016 | Prospective | ICU, Adult, Sepsis (52), SIRS (38) | STREM1 | 0.78 (0.69–0.86) | sTREM1 cut-off value ≥ 133 pg/mL. Sens: 71.1%; Spec: 67.33%; PPV: 80.43; NPV: 65.91 | sTREM1, APACHES II higher in patients with positive culture than negative cultures. sTREM1, PCT and CRP levels, or WBC count performed equally to differentiate |
| PCT | 0.65 (95%CI: 0.53–0.76) | PCT cut-off value of 1.57 ng/mL. Sens: 67.31; Spec: 65.79%; PPV: 72.92; NPV: 70 | ||||
Table 3 Biomarkers for diagnosis of sepsis-current understanding in diagnosis of sepsis
| Biomarker | Diagnosis of sepsis | Differentiating sepsis and SIRS | Guiding antibiotic initiation | Organism identification |
| Procalcitonin | Better than CRP; cannot be used independently; diagnosis based on clinical context | Better than CRP; cannot be used independently; diagnosis based on clinical context | Delays antibiotic administration; No short term mortality benefit | Higher in Gram negative bacteremia than Gram positive. Higher in bacteremia than in candidemia. No defined cutoffs. Treatment to be based on clinical judgement |
| Presepsin | Possible role | Possible role | No significant data | No significant data |
| nCD64 | Possible role; when combined with CRP, higher diagnostic accuracy and high negative predictive value | No significant data | No significant data | Increased in bacterial and viral infection more than fungal |
| suPAR | Possible role | Performed poorly | No significant data | No significant data |
| IL6 | Inferior to PCT, CRP | Inferior to PCT, CRP | No significant data | No significant data |
Table 4 Procalcitonin for prognosis of sepsis
| Ref. | Type of study | Patient population | Aim | No. of patients/studies | Results | Conclusion of study |
| Ryu et al[52], 2015 | Observational | Adults | To compare changes in PCT and CRP concentration in critically ill septic patients to determine which marker better predicts outcome | 157 patients; 171 episodes | CPCTc and CRPc are significantly associated with treatment failure (P = 0.027 and P = 0.03 respectively) and marginally significant with 28 d mortality (P = 0.064 and 0.062 respectively). AUC for prediction of treatment success-PCTc-0.71 (95%CI: 0.61-0.81); CRPc-0.71 (95%CI: 0.61-0.81); AUC for survival prediction-PCTc-0.77 (95%CI: 0.66-0.88); CRPc-0.77 (95%CI: 0.67-0.88) | Changes in PCT and CRP concentrations were associated with outcomes of critically ill septic patients. CRP may not be inferior to PCT in predicting outcomes in these patients |
| Patnaik et al[32], 2020 | Meta-Analysis | Adults | To evaluate the results of all non-clearance of serial PCT as a mortality predictor | 10 studies, 1974 patients | AUC varied between the studies between 0.52 and 0.86. Overall AUC-0.711 (95%CI: 0.662-0.760) under fixed effect model and 0.708 (95%CI: 0.648-0.769) under random effect model. Overall proportion of mortality-37.54% | PCT non clearance is a marker for increased mortality. Optimal cut off points for PCT non clearance in septic patients admitted to ICU are not known |
| Park et al[53], 2013 | Observational | Adults | To evaluate the value of PCT in women with APN at ED | 240 | AUC for predicting 28 d mortality for PCT-0.68. For predicting mortality, a cut off value of 0.42 ng/mL, sensitivity was 80% and specificity was 50%. Disease classification systems were predicted to be superior to PCT in predicting 28 d mortality | By distinguishing the severity of sepsis related to APN mortality, PCT levels help clinicians in disease severity classification and treatment decisions at ED |
| Oberhoffer et al[54], 1999 | Observational | Adults | To predict outcome with traditional and new inflammatory markers in septic patients | 242 | AUC for PCT was 0.878 which was highest as compared to other markers | PCT may be a better marker than other inflammatory markers, CRP, leukocyte count, body temperature to identify patients endangered by severe infection or sepsis |
| Arora et al[31], 2015 | Meta-Analysis | Adults | To study the procalcitonin levels in survivors and non survivors of sepsis | 25 studies; 2353 patients | Mean difference in procalcitonin levels between survivors and non survivors on day 1 (P = 0.02) and day 3 (P = 0.03) was statistically significant | Significantly lower levels of procalcitonin were observed in survivors as compared to non survivors in early stages of sepsis |
Table 5 Presepsin for prognosis of sepsis
| Ref. | Type of study | Patient population | Aim | No. of studies/patients | Results | Conclusion of study |
| Masson et al[33], 2015 | Retrospective case control study | Adults | To evaluate the prognostic value of presepsin and comparison with procalcitonin | 100 | Presepsin levels at day 1 were higher in decedents (2269 pg/mL, median-1171 to 4300 pg/mL) than in survivors (1184 pg/mL, median-875 to 2113 pg/ml); P = 0.002) whereas PCT was not different (18.5 mcg/L, median 3.4 to 45.2) and 10.8 mcg/L (2,7 to 41.9 mcg/L) P = 0.13). The evolution of presepsin levels over time was significantly different in survivors compared to non survivors (P for time-survival interaction-0.03) | Presepsin showed better prognostic accuracy than procalcitonin in the range of SOFA. (AUC: 0.64-0.75 vs AUC: 0.53-0.65) |
| Behnes et al[55], 2014 | Prospective cohort study | Adults | Evaluation of diagnostic and prognostic value of presepsin in sepsis and septic shock patients during the 1st wk of ICU treatment | 116 | AUC- 0.64 TO 0.71; Presepsin cut off values-Sepsis-530 pg/mL; Severe sepsis-600 pg/mL; Septic shock-700 pg/mL | Presepsin has good prognostic value in terms of prognosis for 30 d and 6 mo all cause mortality throughout the 1st wk of ICU stay and its prognostic value for all cause mortality is comparable to that of IL6 and better than that of PCT, CRP or WBC |
| Yang et al[56], 2018 | Meta-Analysis | Adults | To evaluate the mortality prediction value of presepsin in septic patients | 10 studies; 1617 patients | Initial prespesin levels (within 24 h) were significantly lower in survivors as compared to non survivors. Pooled SMD (standardized mean difference) between survivors and non survivors-0.92 (95%CI: 0.62–1.22) | Some mortality prediction of presepsin; further studies may be needed to define optimal cut off points for presepsin to predict mortality in sepsis |
| Wang et al[57], 2020 | Observational | Elderly patients | To investigate the prognostic value of presepsin for elderly septic patients in ICU | 142 | Presepsin levels were significantly higher in infected patients. Day 3 presepsin levels showed a significant prognostic value for 30 d mortality but was not found to be superior to other biomarkers | Early diagnostic ability comparable to that of PCT; however not a perfect biomarker for prognosis of 30 d mortality in elderly patients |
| Koh et al[58], 2021 | Observational | Adults | Estimation of prognostic value of presepsin in septic patients | 153 | AUC for presepsin- 0.656; Presepsin levels > 1176 pg/mL (odds ratio 3.352, P < 0.001) was a risk factor for in hospital mortality | Non survivors had higher presepsin levels; presepsin may have prognostic value |
| Endo et al[59], 2014 | Prospective study | Adults | To compare presepsin with other conventional biomarkers (PCT, CRP, IL6) for evaluating the severity of sepsis | 103 | In patients with unfavorable prognosis: (1) Presepsin levels did not decrease significantly during follow up; (2) Higher duration of antibiotic therapy was used (P < 0.05); and (3) Higher 28 day mortality (P < 0.05) | Presepsin levels correlated with severity during follow up as compared to other conventional biomarkers |
| Masson et al[33], 2015 | Observational | Adults | Evaluating the relationship between presepsin levels and host response, appropriateness of antibiotics, and mortality in severe sepsis patients | 997 patients with severe sepsis or septic shock in ALBIOS trial | Baseline Presepsin concentrations increased with SOFA score, number of organ failures, and incidence of new organ failures; An increasing concentration of presepsin from day 1 to day 2 predicted higher ICU (P < 0.0001) and 90 d mortality (P < 0.01) | Presepsin is an early predictor of host response and mortality in patients with sepsis |
Table 6 Adrenomedullin and pro adrenomedullin for prognosis of sepsis
| Ref. | Type of study | Patient population | Aim | No. of patients | Results | Conclusion of study |
| Christ-Crain et al[34], 2006 | Prospective observational | Adult patients with CAP | To evaluate the value of Pro ADM levels for severity assessment and outcome prediction in CAP | 302 | Pro ADM levels (as compared to CRP and leukocyte count) increased with increasing severity of CAP (calculated through PSI score). Pro ADM levels at admission significantly higher 2.1 (1.5 to 3) nmol/L compared to survivors 1 (0.6 to 1.6) nmol/L; P < 0.001. AUC for proADM was 0.76 (95%CI: 0.71–0.81)-significantly higher than PCT, CRP, TLC | Pro ADM is a useful biomarker for risk stratification in patients with CAP |
| Charles et al[60], 2017 | Prospective cohort | Adults | To assess the prognostic value of PCT, MR pro ADM, copeptin and CT proendothelin1 concentrations | 173 | Day 1 MR-ProADM levels significantly higher in non survivors [8.6 (5.9) vs 4.4 (3.9)] nmol/L; P < 0.0001 | Day 1 MR-ProADM is a good predictor of short term clinical outcome as compared with others |
| Li et al[36], 2018 | Meta-Analysis | Adults | To evaluate the ability of adrenomedullin and Pro Adm to predict mortality in septic patients | 13 studies; 2556 patients | Increased AM or Pro ADM levels are associated with increased mortality (pooled RR = 3.31; 95%CI: 2.31-4.75); AUC 0.8 (95%CI: 0.77-0.84) | AM and Pro ADM may be used as prognostic markers in sepsis |
| Chen and Li[61], 2013 | Observational | Adults | To evaluate the prognostic value of adrenomedullin in septic patients and compare it with PCT and MEDS | 837 | Mean levels (at admission of AM were 28.66 ± 6.05 ng/L in 100 healthy controls, 31.65 ± 6.47 ng/L in 153 systemic inflammatory response syndrome patients, 33.24 ± 8.59 ng/L in 376 sepsis patients, 34.81 ± 8.33 ng/L in 210 severe sepsis patients, and 45.15 ± 9.87 ng/L in 98 septic shock patients. The differences between the 2 groups were significant. ADM levels significantly higher in non survivors; AUC for in hospital mortality-AM-0.773; PCT-0.701; MEDS-0.721 | Adrenomedullin is valuable prognostic biomarker for septic patients in ED |
| Caironi et al[62], 2017 | Observational | Adults | To evaluate the role of Bio ADM | 956 | Plasma bio ADM (day 1) was higher in and associated with higher 90 d mortality, multi organ failures, extent of haemodynamic support and serum lactate time course over the 1st wk. Bio ADM trajectory during the 1st wk of treatment predicted 90 d mortality; Reduction to levels below 110 pg/ml at day 7 was associated with reduction in 90 d mortality | Bio ADM levels may help individualize haemodynamic support therapy in septic patients |
| Elke et al[63], 2018 | Secondary analysis of RCT | Adults | To evaluate role of MR Pro Adm compared to conventional biomarkers (PCT, CRP, lactate) and clinical scores to identify disease severity in sepsis | 1089 | MR Pro Adm had strongest association with mortality and high disease severity; A decreasing concentration of PCT by ≥ 20 % from baseline to day 1 or ≥ 50 % from baseline to day 4 but a persisting high level of Pro Adm had significantly increased mortality risk [HR (95%CI)-19 (8-45.9) and 43.1 (10.1-184)] | MR Pro Adm assesses disease severity and treatment response more accurately than conventional biomarkers and scores |
Table 7 Soluble urokinase plasminogen activator receptor for prognosis of sepsis
| Ref. | Type of study | Patient population | Aim | No. of patients | Results | Conclusion of study |
| Backes et al[64], 2012 | Systematic review | Adults | To assess the usefulness of suPAR levels in critically ill patients with sepsis, SIRS, bacteraemia, focusing (diagnostic and prognostic value) | 10 studies | Little diagnostic value in critically ill septic patients. Superior prognostic value in such patients as compared to other markers. Improved mortality prediction by combining suPAR with other markers or disease severity classifications. suPAR levels correlate positively with markers of organ dysfunction and severity of disease classification system scores | suPAR has a low diagnostic value for septic patients. It may add to prognostication with other markers and organ dysfunction scores |
| Huang et al[18], 2020 | Systematic review | Adults | To evaluate the value of suPAR for diagnosis and prognosis of sepsis | 30 studies, 6906 patients | Pooled sensitivity and specifity for predicting mortality-0.74 (95%CI: 0.67-0.8) and 0.7 (95%CI: 0.63-0.76) with AUC of 0.78 (95%CI: 0.74-0.82) | suPAR is a good maker for prognostication of sepsis |
| Pregernig et al[65], 2019 | Meta-Analysis | Adults | To assess the prognostic value of suPAR and 6 other biomarkers in predicting mortality in adult septic patients | 28 studies included | Pooled mean differences in marker concentrations (survivors-non survivors) at onset of sepsis for suPAR-5.2 ng/mL; 95%CI: 4.5-6; P < 0.01) | suPAR can provide prognostication information about mortality in adult septic patients |
| Ni et al[66], 2016 | Meta-Analysis | Adults | To evaluate the usefulness of suPAR for diagnosis and prognosis of bacterial infections | 17 studies included | High suPAR levels were related with a significantly increased risk of death with a pooled risk ratio of 3.37 (95%CI: 2.6-4.38). Pooled sensitivity and specificity for predicting mortality were 0.7 and 0.72 respectively, with AUC of 0.77 | suPAR can be used for prognosis of bacterial infection |
Table 8 Soluble triggering receptor expressed on myeloid cells 1 for prognosis of sepsis
| Ref. | Type of study | Patient population | Aim | No. of patients/studies | Results | Conclusion of study |
| Su et al[67], 2016 | Systematic review | Adults | To determine prognostic value of sTREM1 in predicting mortality at the initial stage of infection | 9 studies | High sTREM1 level was associated with higher risk of death in infection, with pooled RR 2.54 (95%CI: 0.61-0.86) using a random effects model; Pooled sensitivity and specificity of sTREM1 to predict mortality in infection were 0.75 (95%CI: 0.61-0.86) and 0.66 (95%CI: 0.54-0.75), respectively | Higher sTREM1 levels had a moderate prognostic significance in assessing the mortality of infection in adult patients; however sTREM1 alone is not sufficient to predict mortality as a marker |
| Su et al[68], 2012 | Observational | Adults | To study the association of sepsis prognosis with dynamic changes in sTREM1 and its polymorphisms | 160 | sTREM1 levels were significantly raised in non survivors than in survivors (P < 0.001); Logistic regression showed that sTREM1, APACHE 2, and rs2234237 polymorphisms are risk factors for prognosis | Dynamic changes in sTREM1 and rs2234237 polymorphism could be used for prognostication in septic patients |
| Wang et al[69], 2011 | Observational | Adults | To observe dynamic changes in plasma sTREM1 levels and to study its effect on predicting outcome of septic patients combined with SOFA score | 57 | Non survivors-sTREM1 levels were highest on Day 1 and a gradual elevation was seen over days 1, 3 and 7). Survivor-sTREM levels were highest on day 1 and then showed a gradual reduction over days 1, 3 and 7. sTREM levels were significantly higher in non survivors as compared to survivors (P < 0.01) | High plasma levels of sTREM1 are detected at initial stages in septic patients and sTREM1 level combined with SOFA score may be helpful in predicting outcomes in septic patients |
- Citation: Ahuja N, Mishra A, Gupta R, Ray S. Biomarkers in sepsis-looking for the Holy Grail or chasing a mirage! World J Crit Care Med 2023; 12(4): 188-203
- URL: https://www.wjgnet.com/2220-3141/full/v12/i4/188.htm
- DOI: https://dx.doi.org/10.5492/wjccm.v12.i4.188