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Published on: August 12, 2020
Early-Onset Neonatal Sepsis: Still Room for Improvement in Procalcitonin Diagnostic Accuracy Studies
Claudio Chiesa1, Lucia Pacifico, John F Osborn
1From the Institute of Translational Pharmacology, National Research Council (CC), Department of Pediatrics and Child Neuropsychiatry (LP), Department of Public Health and Infectious Diseases (JFO), Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy (EB); and Research Unit for Neonatal Infectious Diseases and Epidemiology, Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria (NH, BR).
Insights
The quality of studies on procalcitonin (PCT) for early-onset neonatal sepsis (EONS) diagnosis is suboptimal. Improved reporting using STARD guidelines is needed for reliable PCT test interpretation in neonates.
Area of Science:
- Neonatology
- Diagnostic Accuracy
- Biomarkers
Background:
- Early-onset neonatal sepsis (EONS) is a significant clinical challenge.
- Procalcitonin (PCT) shows potential as a diagnostic marker for EONS, but study results are inconsistent.
- Study quality may explain discrepancies in PCT's diagnostic utility for EONS.
Purpose of the Study:
- To systematically review the accuracy and completeness of diagnostic studies on PCT for EONS.
- To assess study quality using the Standards for Reporting of Diagnostic Accuracy (STARD) initiative.
Main Methods:
- Systematic review of PubMed, Scopus, and Cochrane Library databases up to October 1, 2014.
- Inclusion criteria: studies reporting PCT accuracy measures for EONS diagnosis.
- Data extraction and quality appraisal using a STARD-based checklist adapted for neonatal sepsis.
Main Results:
- 18 articles published between 1998 and 2014 were included.
- The overall quality of reporting for diagnostic accuracy studies of PCT in EONS was suboptimal.
- Key information regarding study design, analysis, and interpretation of test accuracy was frequently missing.
Conclusions:
- There is a need for improvement in the quality of research reporting on PCT for EONS.
- Adherence to STARD guidelines is recommended for future studies.
- Well-reported studies are crucial for reliable guidance on PCT use in managing neonatal sepsis.
Abstract:
To perform a systematic review assessing accuracy and completeness of diagnostic studies of procalcitonin (PCT) for early-onset neonatal sepsis (EONS) using the Standards for Reporting of Diagnostic Accuracy (STARD) initiative.EONS, diagnosed during the first 3 days of life, remains a common and serious problem. Increased PCT is a potentially useful diagnostic marker of EONS, but reports in the literature are contradictory. There are several possible explanations for the divergent results including the quality of studies reporting the clinical usefulness of PCT in ruling in or ruling out EONS.We systematically reviewed PubMed, Scopus, and the Cochrane Library databases up to October 1, 2014. Studies were eligible for inclusion in our review if they provided measures of PCT accuracy for diagnosing EONS. A data extraction form based on the STARD checklist and adapted for neonates with EONS was used to appraise the quality of the reporting of included studies.We found 18 articles (1998-2014) fulfilling our eligibility criteria which were included in the final analysis. Overall, the results of our analysis showed that the quality of studies reporting diagnostic accuracy of PCT for EONS was suboptimal leaving ample room for improvement. Information on key elements of design, analysis, and interpretation of test accuracy were frequently missing.Authors should be aware of the STARD criteria before starting a study in this field. We welcome stricter adherence to this guideline. Well-reported studies with appropriate designs will provide more reliable information to guide decisions on the use and interpretations of PCT test results in the management of neonates with EONS.
