Accuracy of pancreatic stone protein for the diagnosis of infection in hospitalized adults: a systematic review and individual patient level meta-analysis

Abstract

Background Accurate biomarkers to diagnose infection are lacking. Studies reported good performance of pancreatic stone protein (PSP) to detect infection. The objective of the study was to determine the performance of PSP in diagnosing infection across hospitalized patients and calculate a threshold value for that purpose. Methods A systematic search across Cochrane Central Register of Controlled Trials and MEDLINE databases (1966–March 2019) for studies on PSP published in English using ‘pancreatic stone protein’, ‘PSP’, ‘regenerative protein’, ‘lithostatin’ combined with ‘infection’ and ‘sepsis’ found 44 records. The search was restricted to the five trials that evaluated PSP for the initial detection of infection in hospitalized adults. Individual patient data were obtained from the investigators of all eligible trials. Data quality and validity was assessed according to PRISMA guidelines. We choose a fixed-effect model to calculate the PSP cut-off value that best discriminates infected from non-infected patients. Results Infection was confirmed in 371 of 631 patients. The median (IQR) PSP value of infected versus uninfected patients was 81.5 (30.0–237.5) versus 19.2 (12.6–33.57) ng/ml, compared to 150 (82.70–229.55) versus 58.25 (15.85–120) mg/l for C-reactive protein (CRP) and 0.9 (0.29–4.4) versus 0.15 (0.08–0.5) ng/ml for procalcitonin (PCT). Using a PSP cut-off of 44.18 ng/ml, the ROC AUC to detect infection was 0.81 (0.78–0.85) with a sensitivity of 0.66 (0.61–0.71), specificity of 0.83 (0.78–0.88), PPV of 0.85 (0.81–0.89) and NPV of 0.63 (0.58–0.68). When a model combining PSP and CRP was used, the ROC AUC improved to 0.90 (0.87–0.92) with higher sensitivity 0.81 (0.77–0.85) and specificity 0.84 (0.79–0.90) for discriminating infection from non-infection. Adding PCT did not improve the performance further. Conclusions PSP is a promising biomarker to diagnose infections in hospitalized patients. Using a cut-off value of 44.18 ng/ml, PSP performs better than CRP or PCT across the considered studies. The combination of PSP with CRP further enhances its accuracy.

Pancreatic stone protein for early mortality prediction in COVID-19 patients

“…Pancreatic stone protein (PSP) is a novel biomarker for infection and sepsis with promising results in various clinical settings [ 2 ]. A meta-analysis showed that PSP performed better than C-reactive protein (CRP) and procalcitonin for detecting infection among hospitalized patients, and that the combination of PSP and CRP further enhanced its accuracy [ 3 ]. Recently, serial measurement of PSP in patients admitted to the intensive care unit (ICU) allowed early detection of sepsis [ 4 ].…”

Pancreatic stone protein as a biomarker for the early diagnosis of post-operative peritonitis, intra-abdominal infection and sepsis

“…However, their values for identifying abdominal sepsis have yielded conflicting results [ 6 ]. A recent literature review [ 7 ] of 23 studies including a prospective multi-center study [ 4 ] and a meta-analysis [ 8 ] suggests that PSP has a higher diagnostic performance for the identification of infection and sepsis than the most used available biomarkers. The multi-center study shows that serial routine PSP measurement has the potential of ‘pre-symptomatic diagnosis of sepsis’ up to 72 h in advance with an optimal PSP cut-off of 290 ng/ml [ 4 ].…”

Comparison of patients with community-acquired and hospital-acquired sepsis or septic shock: a systematic review and meta-analysis

“…PSP is a promising biomarker to diagnose infections in hospitalized patients. Using a cut-off value of 44.18 ng/ml, PSP performs better than CRP or PCT across the considered studies [34]. Pentraxin-3 (PTX3) level was signi cantly higher in non-survivor compared to survivor patients with sepsis.…”