Biomarkers for the early diagnosis of sepsis in burns: Systematic review and metaanalysis.

Abstract

Introduction: Early clinical diagnosis of sepsis in burns patients is notoriously difficult, and many biomarkers have been proposed as adjuncts to clinical assessment. We aimed to evaluate the diagnostic performance of all previously studied biomarkers for the early diagnosis of sepsis in hospitalized patients with burns. Method(s): We conducted a systematic literature search to February 2020 of Medline, Embase, Cochrane Central, Biosis Previews, Web of Science, and Medline In-Process. Only diagnostic studies utilising a sepsis definition of positive blood cultures or a combination of infection, systemic inflammation, and organ dysfunction were included. Where possible, contingency tables were used as reported or constructed from original data using a cut-off based on Youden's index. Pooled sensitivity and specificity estimates were derived for each biomarker using random effects meta-analysis. Result(s): We included 27 studies evaluating 56 different biomarkers. Procalcitonin was moderately sensitive and specific for sepsis in patients with burns (sensitivity 72%, specificity 74%). CRP was also moderately sensitive and specific (74% and 64% respectively). White cell count had poor sensitivity and specificity (46% and 59% respectively). All other biomarkers had insufficient studies to include in a metaanalysis, however cell free DNA, nuclear DNA, BDG, BNP, and SVI showed the most promise in single studies. There was considerable heterogeneity between studies reflecting different definitions and cut-offs. Conclusion(s): The most widely studied biomarkers are poorly predictive for sepsis in burn patients. Several promising candidates have been reported which should be evaluated in further studies. A standardized approach to the evaluation of diagnostic markers (including time of sampling, approach to cut-offs and outcome) would be useful.