Biomarkers for the Early Diagnosis of Sepsis in Burns: Systematic Review and Meta-analysis.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 04 2022
01 04 2022
Historique:
entrez:
9
3
2022
pubmed:
10
3
2022
medline:
27
4
2022
Statut:
ppublish
Résumé
The aim of this study was to evaluate the diagnostic performance of all biomarkers studied to date for the early diagnosis of sepsis in hospitalized patients with burns. Early clinical diagnosis of sepsis in burns patients is notoriously difficult due to the hypermetabolic nature of thermal injury. A considerable variety of biomarkers have been proposed as potentially useful adjuncts to assist with making a timely and accurate diagnosis. We searched Medline, Embase, Cochrane CENTRAL, Biosis Previews, Web of Science, and Medline In-Process to February 2020. We included diagnostic studies involving burns patients that assessed biomarkers against a reference sepsis definition of positive blood cultures or a combination of microbiologically proven infection with systemic inflammation and/or organ dysfunction. Pooled measures of diagnostic accuracy were derived for each biomarker using bivariate random-effects meta-analysis. We included 28 studies evaluating 57 different biomarkers and incorporating 1517 participants. Procalcitonin was moderately sensitive (73%) and specific (75%) for sepsis in patients with burns. C-reactive protein was highly sensitive (86%) but poorly specific (54%). White blood cell count had poor sensitivity (47%) and moderate specificity (65%). All other biomarkers had insufficient studies to include in a meta-analysis, however brain natriuretic peptide, stroke volume index, tumor necrosis factor (TNF)-alpha, and cell-free DNA (on day 14 post-injury) showed the most promise in single studies. There was moderate to significant heterogeneity reflecting different study populations, sepsis definitions and test thresholds. The most widely studied biomarkers are poorly predictive for sepsis in burns patients. Brain natriuretic peptide, stroke volume index, TNF-alpha, and cell-free DNA showed promise in single studies and should be further evaluated. A standardized approach to the evaluation of diagnostic markers (including time of sampling, cut-offs, and outcomes) would be useful.
Sections du résumé
OBJECTIVE
The aim of this study was to evaluate the diagnostic performance of all biomarkers studied to date for the early diagnosis of sepsis in hospitalized patients with burns.
BACKGROUND
Early clinical diagnosis of sepsis in burns patients is notoriously difficult due to the hypermetabolic nature of thermal injury. A considerable variety of biomarkers have been proposed as potentially useful adjuncts to assist with making a timely and accurate diagnosis.
METHODS
We searched Medline, Embase, Cochrane CENTRAL, Biosis Previews, Web of Science, and Medline In-Process to February 2020. We included diagnostic studies involving burns patients that assessed biomarkers against a reference sepsis definition of positive blood cultures or a combination of microbiologically proven infection with systemic inflammation and/or organ dysfunction. Pooled measures of diagnostic accuracy were derived for each biomarker using bivariate random-effects meta-analysis.
RESULTS
We included 28 studies evaluating 57 different biomarkers and incorporating 1517 participants. Procalcitonin was moderately sensitive (73%) and specific (75%) for sepsis in patients with burns. C-reactive protein was highly sensitive (86%) but poorly specific (54%). White blood cell count had poor sensitivity (47%) and moderate specificity (65%). All other biomarkers had insufficient studies to include in a meta-analysis, however brain natriuretic peptide, stroke volume index, tumor necrosis factor (TNF)-alpha, and cell-free DNA (on day 14 post-injury) showed the most promise in single studies. There was moderate to significant heterogeneity reflecting different study populations, sepsis definitions and test thresholds.
CONCLUSIONS
The most widely studied biomarkers are poorly predictive for sepsis in burns patients. Brain natriuretic peptide, stroke volume index, TNF-alpha, and cell-free DNA showed promise in single studies and should be further evaluated. A standardized approach to the evaluation of diagnostic markers (including time of sampling, cut-offs, and outcomes) would be useful.
Identifiants
pubmed: 35261389
doi: 10.1097/SLA.0000000000005198
pii: 00000658-202204000-00008
doi:
Substances chimiques
Biomarkers
0
Cell-Free Nucleic Acids
0
Natriuretic Peptide, Brain
114471-18-0
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
654-662Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315:801–810.
Mann EA, Baun MM, Meininger JC, et al. Comparison of mortality associated with sepsis in the burn, trauma, and general intensive care unit patient: a systematic review of the literature. Shock 2012; 37:4–16.
Gaieski DF, Mikkelsen ME, Band RA, et al. Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department. Crit Care Med 2010; 38:1045–1053.
Nielson CB, Duethman NC, Howard JM, et al. Burns: pathophysiology of systemic complications and current management. J Burn Care Res 2017; 38:e469–e481.
Lavrentieva A, Kontakiotis T, Lazaridis L, et al. Inflammatory markers in patients with severe burn injury. What is the best indicator of sepsis? Burns 2007; 33:189–194.
Greenhalgh DG. Sepsis in the burn patient: a different problem than sepsis in the general population. Burns Trauma 2017; 5:23.
Garnacho-Montero J, Ortiz-Leyba C, Herrera-Melero I, et al. Mortality and morbidity attributable to inadequate empirical antimicrobial therapy in patients admitted to the ICU with sepsis: a matched cohort study. J Antimicrob Chemother 2008; 61:436–441.
Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992; 101:1644–1655.
Greenhalgh DG, Saffle JR, Holmes JH, et al. American Burn Association consensus conference to define sepsis and infection in burns. J Burn Care Res 2007; 28:776–790.
Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003; 31:1250–1256.
Cabral L, Afreixo V, Almeida L, et al. The use of procalcitonin (PCT) for diagnosis of sepsis in burn patients: a meta-analysis. PLoS One 2016; 11:e0168475.
Ren H, Li Y, Han C, et al. Serum procalcitonin as a diagnostic biomarker for sepsis in burned patients: a meta-analysis. Burns 2015; 41:502–509.
Cabral L, Afreixo V, Santos F, et al. Procalcitonin for the early diagnosis of sepsis in burn patients: a retrospective study. Burns 2017; 43:1427–1434.
Hollén L, Hughes R, Dodds N, et al. Use of procalcitonin as a biomarker for sepsis in moderate to major paediatric burns. Trauma 2018; 21:192–200.
Wineberg D, Moore R, Kruger D. Procalcitonin and bacterial sepsis in burn patients in South Africa. J Surg Res 2020; 246:490–498.
Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339:b2535.
Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011; 155:529–536.
Gille J, Ostermann H, Dragu A, et al. MR-proADM: a new biomarker for early diagnosis of sepsis in burned patients. J Burn Care Res 2017; 38:290–298.
Neiverth A, Prim LR, Franck CL, et al. Sepsis in burned adult patients: study of serie of cases in Brazil. J Burn Care Res 2020; 41:900–904.
Denk S, Perl M, Huber-Lang M. Damage- and pathogen-associated molecular patterns and alarmins: keys to sepsis? Eur Surg Res 2012; 48:171–179.
Levin ER, Gardner DG, Samson WK. Natriuretic peptides. N Engl J Med 1998; 339:321–328.
McLean AS, Tang B, Nalos M, et al. Increased B-type natriuretic peptide (BNP) level is a strong predictor for cardiac dysfunction in intensive care unit patients. Anaesth Intensive Care 2003; 31:21–27.
Parker MM, McCarthy KE, Ognibene FP, et al. Right ventricular dysfunction and dilatation, similar to left ventricular changes, characterize the cardiac depression of septic shock in humans. Chest 1990; 97:126–131.
Paratz JD, Lipman J, Boots RJ, et al. A new marker of sepsis post burn injury? Criti Care Med 2014; 42:2029–2036.
Zhou B, Zhu J, Mao Z, et al. Roles of procalcitonin and n-terminal pro-B-type natriuretic peptide in predicting catheter-related bloodstream infection in severe burn injury patients. Dis Markers 2018; 2018:5607932.
Merx MW, Weber C. Sepsis and the heart. Circulation 2007; 116:793–802.
Kaita Y, Tarui T, Otsu A, et al. The Clinical significance of serum 1,3-beta-d-glucan for the diagnosis of candidemia in severe burn patients. J Burn Care Res 2019; 40:104–106.
Shupp JW, Petraitiene R, Jaskille AD, et al. Early serum (1-->3)-beta-D-glucan levels in patients with burn injury. Mycoses 2012; 55:224–227.
Everitt AS, Frame JD, Gurney JR, et al. Tumour necrosis factor: a response to sepsis in the burned child? Intensive and Critical Care Medicine 1990; 885:1154–1155.
Hampson P, Dinsdale RJ, Wearn CM, et al. Neutrophil dysfunction, immature granulocytes, and cell-free DNA are early biomarkers of sepsis in burn-injured patients: a prospective observational cohort study. Ann Surg 2017; 265:1241–1249.
Bossuyt PM, Reitsma JB, Bruns DE, et al. The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Ann Intern Med 2003; 138:W1–12.
Cabral L, Afreixo V, Meireles R, et al. Procalcitonin kinetics after burn injury and burn surgery in septic and non-septic patients - a retrospective observational study. BMC Anesthesiol 2018; 18:122.
Yan J, Hill WF, Rehou S, et al. Sepsis criteria versus clinical diagnosis of sepsis in burn patients: A validation of current sepsis scores. Surgery 2018; 164:1241–1245.
Barati M, Alinejad F, Bahar MA, et al. Comparison of WBC, ESR, CRP and PCT serum levels in septic and non-septic burn cases. Burns 2008; 34:770–774.
Bargues L, Chancerelle Y, Catineau J, et al. Evaluation of serum procalcitonin concentration in the ICU following severe burn. Burns 2007; 33:860–864.
Bergquist M, Huss F, Hastbacka J, et al. Glucocorticoid receptor expression and binding capacity in patients with burn injury. Acta Anaesthesiol Scand 2016; 60:213–221.
Bognar Z, Foldi V, Rezman B, et al. Extravascular lung water index as a sign of developing sepsis in burns. Burns 2010; 36:1263–1270.
Cakir Madenci O, Yakupoglu S, Benzonana N, et al. Evaluation of soluble CD14 subtype (presepsin) in burn sepsis. Burns 2014; 40:664–669.
Egea-Guerrero JJ, Martinez-Fernandez C, Rodriguez-Rodriguez A, et al. The utility of C-reactive protein and procalcitonin for sepsis diagnosis in critically burned patients: a preliminary study. Plast Surg (Oakv) 2015; 23:239–243.
Hill DM, Percy MD, Velamuri SR, et al. Predictors for identifying burn sepsis and performance vs existing criteria. J Burn Care Res 2018; 39:982–988.
Jones CN, Moore M, Dimisko L, et al. Spontaneous neutrophil migration patterns during sepsis after major burns. PLoS One 2014; 9:e114509.
Klein HJ, Niggemann P, Buehler PK, et al. Pancreatic stone protein predicts sepsis in severely burned patients irrespective of trauma severity: a monocentric observational study. Ann Surg 2021; 274:e1179–e1186.
Kumar H, Barreto E, Paul M, et al. Procalcitonin: promising biomarker to detect sepsis in burns – A prospective study. Indian J Burns 2018; 26:87–92.
Lavrentieva A, Papadopoulou S, Kioumis J, et al. PCT as a diagnostic and prognostic tool in burn patients. Whether time course has a role in monitoring sepsis treatment. Burns 2012; 38:356–363.
McManus AT, Lindberg RB, Pruitt BA Jr, et al. Association of endotoxemia and bacteremia in burn patients: a prospective study. Prog Clin Biol Res 1979; 29:275–278.
Mokline A, Garsallah L, Rahmani I, et al. Procalcitonin: a diagnostic and prognostic biomarker of sepsis in burned patients. Ann Burn Fire Disasters 2015; 28:116–120.
Neely AN, Fowler LA, Kagan RJ, et al. Procalcitonin in pediatric burn patients: an early indicator of sepsis? J Burn Care Rehabil 2004; 25:76–80.
Seoane L, Pertega S, Galeiras R, et al. Procalcitonin in the burn unit and the diagnosis of infection. Burns 2014; 40:223–229.
Vargo JD, Grow JN, Yang S, et al. Parameters for Ordering Blood Cultures in Major Burn Injury Patients: Improving Clinical Assessment. J Burn Care Res 2018; 39:445–449.
Williams JW, Craig CK, Emerman MA, et al. Utilization of a burn sepsis algorithm: Should we abandon the consensus criteria? J Burn Care Res 2018; 39: (suppl 1): S27.