Systematic review and meta-analysis of the diagnostic value of four biomarkers in detecting neonatal sepsis in low- and middle-income countries
Background Biomarkers may enhance diagnostic capability for common paediatric infections, especially in low- and middle-income countries (LMICs) where standard diagnostic modalities are frequently unavailable, but disease burden is high. A comprehensive understanding of the diagnostic capability of...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-12-01
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| Series: | BMJ Paediatrics Open |
| Online Access: | https://bmjpaedsopen.bmj.com/content/7/1/e001627.full |
| _version_ | 1797367981114654720 |
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| author | Chris A Rees Jamie Lim Michelle Niescierenko Julia Rubin-Smith Alexis Schmid Adrianna L Westbrook Rachelle El Helou Kyra Shreeve Chloe Rotman Sindu Govindapillai Kate Dorney |
| author_facet | Chris A Rees Jamie Lim Michelle Niescierenko Julia Rubin-Smith Alexis Schmid Adrianna L Westbrook Rachelle El Helou Kyra Shreeve Chloe Rotman Sindu Govindapillai Kate Dorney |
| author_sort | Chris A Rees |
| collection | DOAJ |
| description | Background Biomarkers may enhance diagnostic capability for common paediatric infections, especially in low- and middle-income countries (LMICs) where standard diagnostic modalities are frequently unavailable, but disease burden is high. A comprehensive understanding of the diagnostic capability of commonly available biomarkers for neonatal sepsis in LMICs is lacking. Our objective was to systematically review evidence on biomarkers to understand their diagnostic performance for neonatal sepsis in LMICs.Methods We conducted a systematic review and meta-analysis of studies published in English, Spanish, French, German, Dutch, and Arabic reporting the diagnostic performance of C reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell count (WBC) and procalcitonin (PCT) for neonatal sepsis. We calculated pooled test characteristics and the area under the curve (AUC) for each biomarker compared with the reference standards blood culture or clinical sepsis defined by each article.Results Of 6570 studies related to biomarkers in children, 134 met inclusion criteria and included 23 179 neonates. There were 80 (59.7%) studies conducted in LMICs. CRP of ≥60 mg/L (AUC 0.87, 95% CI 0.76 to 0.91) among 1339 neonates and PCT of ≥0.5 ng/mL (AUC 0.87, 95% CI 0.70 to 0.92) among 617 neonates demonstrated the greatest discriminatory value for the diagnosis of neonatal sepsis using blood culture as the reference standard in LMICs.Conclusions PCT and CRP had good discriminatory value for neonatal sepsis in LMICs. ESR and WBC demonstrated poor discrimination for neonatal sepsis in LMICs. Future studies may incorporate biomarkers into clinical evaluation in LMICs to diagnose neonatal sepsis more accurately.PROSPERO registration number CRD42020188680. |
| first_indexed | 2024-03-08T17:25:56Z |
| format | Article |
| id | doaj.art-b264e92f7caa4005a6f23b44ee1fbd85 |
| institution | Directory Open Access Journal |
| issn | 2399-9772 |
| language | English |
| last_indexed | 2024-03-08T17:25:56Z |
| publishDate | 2023-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Paediatrics Open |
| spelling | doaj.art-b264e92f7caa4005a6f23b44ee1fbd852024-01-02T20:50:08ZengBMJ Publishing GroupBMJ Paediatrics Open2399-97722023-12-017110.1136/bmjpo-2022-001627Systematic review and meta-analysis of the diagnostic value of four biomarkers in detecting neonatal sepsis in low- and middle-income countriesChris A Rees0Jamie Lim1Michelle Niescierenko2Julia Rubin-Smith3Alexis Schmid4Adrianna L Westbrook5Rachelle El Helou6Kyra Shreeve7Chloe Rotman8Sindu Govindapillai9Kate Dorney10Emergency Medicine, Children`s Healthcare of Atlanta, Atlanta, Georgia, USA3 Advanced Practice NurseDivision of Emergency Medicine, Boston Children s Hospital, Boston, Massachusetts, USAGlobal Health Program, Boston Children`s Hospital, Boston, Massachusetts, USAGlobal Health Program, Boston Children`s Hospital, Boston, Massachusetts, USAPediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, Georgia, USA5 Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA7 Global Health Program, Boston Children’s Hospital, Boston, Massachusetts, USA8 Medical Library, Boston Children’s Hospital, Boston, Massachusetts, USA9 Department of Pediatrics, Qikiqtani General Hospital, Iqaluit, Nunavut, Canada5 Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, USABackground Biomarkers may enhance diagnostic capability for common paediatric infections, especially in low- and middle-income countries (LMICs) where standard diagnostic modalities are frequently unavailable, but disease burden is high. A comprehensive understanding of the diagnostic capability of commonly available biomarkers for neonatal sepsis in LMICs is lacking. Our objective was to systematically review evidence on biomarkers to understand their diagnostic performance for neonatal sepsis in LMICs.Methods We conducted a systematic review and meta-analysis of studies published in English, Spanish, French, German, Dutch, and Arabic reporting the diagnostic performance of C reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell count (WBC) and procalcitonin (PCT) for neonatal sepsis. We calculated pooled test characteristics and the area under the curve (AUC) for each biomarker compared with the reference standards blood culture or clinical sepsis defined by each article.Results Of 6570 studies related to biomarkers in children, 134 met inclusion criteria and included 23 179 neonates. There were 80 (59.7%) studies conducted in LMICs. CRP of ≥60 mg/L (AUC 0.87, 95% CI 0.76 to 0.91) among 1339 neonates and PCT of ≥0.5 ng/mL (AUC 0.87, 95% CI 0.70 to 0.92) among 617 neonates demonstrated the greatest discriminatory value for the diagnosis of neonatal sepsis using blood culture as the reference standard in LMICs.Conclusions PCT and CRP had good discriminatory value for neonatal sepsis in LMICs. ESR and WBC demonstrated poor discrimination for neonatal sepsis in LMICs. Future studies may incorporate biomarkers into clinical evaluation in LMICs to diagnose neonatal sepsis more accurately.PROSPERO registration number CRD42020188680.https://bmjpaedsopen.bmj.com/content/7/1/e001627.full |
| spellingShingle | Chris A Rees Jamie Lim Michelle Niescierenko Julia Rubin-Smith Alexis Schmid Adrianna L Westbrook Rachelle El Helou Kyra Shreeve Chloe Rotman Sindu Govindapillai Kate Dorney Systematic review and meta-analysis of the diagnostic value of four biomarkers in detecting neonatal sepsis in low- and middle-income countries BMJ Paediatrics Open |
| title | Systematic review and meta-analysis of the diagnostic value of four biomarkers in detecting neonatal sepsis in low- and middle-income countries |
| title_full | Systematic review and meta-analysis of the diagnostic value of four biomarkers in detecting neonatal sepsis in low- and middle-income countries |
| title_fullStr | Systematic review and meta-analysis of the diagnostic value of four biomarkers in detecting neonatal sepsis in low- and middle-income countries |
| title_full_unstemmed | Systematic review and meta-analysis of the diagnostic value of four biomarkers in detecting neonatal sepsis in low- and middle-income countries |
| title_short | Systematic review and meta-analysis of the diagnostic value of four biomarkers in detecting neonatal sepsis in low- and middle-income countries |
| title_sort | systematic review and meta analysis of the diagnostic value of four biomarkers in detecting neonatal sepsis in low and middle income countries |
| url | https://bmjpaedsopen.bmj.com/content/7/1/e001627.full |
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