Comparison of the diagnostic accuracies of various biomarkers and scoring systems for sepsis: A systematic review and Bayesian diagnostic test accuracy network meta-analysis.

Summary

This Bayesian diagnostic test accuracy network meta-analysis of 78 studies (34,234 patients) shows that CD64 has the highest diagnostic performance for sepsis, outperforming sTREM-1, presepsin, and clinical scores such as qSOFA and SIRS. Heterogeneity was explained by study design, sepsis prevalence, sample size, and selection bias.

Key Findings

• Included 78 studies and 34,234 patients comparing biomarkers and clinical scores for sepsis diagnosis.
• CD64 achieved the highest diagnostic performance (DOR 20.17; moderate evidence), surpassing sTREM-1 and presepsin.
• Biomarkers outperformed qSOFA and SIRS in detecting sepsis under updated definitions.
• Meta-regression identified study design, sepsis proportion, sample size, and selection bias as major sources of heterogeneity.

Clinical Implications

Consider incorporating CD64 into sepsis screening/triage workflows, potentially alongside existing markers. Implementation should account for assay availability, turnaround time, and cost.

Limitations

• Variability in assay platforms and cut-offs across studies may affect comparability
• Overall evidence quality ranged from moderate to low; possible publication and selection biases

Future Directions

Prospective head-to-head diagnostic studies with standardized assays and cut-offs, evaluation of multi-marker panels, and implementation studies including cost-effectiveness.