Calprotetina circulante e biomarcadores relacionados ao S100A8/A9 para diagnóstico e estratificação prognóstica na infecção aguda e sepse adulta: revisão sistemática e metanálise

Resumo original em inglês

O que aconteceu

Circulating calprotectin is a proposed marker of acute innate immune activation, but reported diagnostic and prognostic performance is inconsistent. We assessed circulating calprotectin and S100A8/A9-related biomarkers for diagnosing acute infection and sepsis and stratifying prognosis in adults.

We searched biomedical databases and trial registries through July 4, 2026, for adult studies of circulating calprotectin/S100A8/A9 in acute infection or sepsis. Random-effects models pooled diagnostic and reported prognostic areas under the receiver operating characteristic curve (AUC). Threshold-based sensitivity and specificity were analyzed separately using bivariate random-effects models. We used the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess diagnostic risk of bias and evidence certainty. Exploratory subgroup, sensitivity, biomarker-comparison, and combined-model analyses were also performed.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420261441569, identifier CRD420261441569.

O que encontraram

Twenty-two reports representing 21 independent cohorts were included. The primary diagnostic meta-analysis yielded a pooled AUC of 0.741 (95% confidence interval [CI], 0.657-0.810). The pooled AUC was 0.703 (95% CI, 0.600-0.789) for sepsis and 0.758 (95% CI, 0.636-0.849) for acute infection or infection-source-related outcomes. In separate threshold-based analyses, pooled sensitivity and specificity were 0.70 (95% CI, 0.46-0.86) and 0.57 (95% CI, 0.55-0.59) for sepsis, and 0.46 (95% CI, 0.09-0.88) and 0.86 (95% CI, 0.60-0.96) for acute infection or infection-source-related outcomes, respectively. For mortality/survival outcomes, pooled sensitivity and specificity were 0.72 (95% CI, 0.65-0.77) and 0.66 (95% CI, 0.53-0.77), respectively, while the pooled reported prognostic AUC was 0.737 (95% CI, 0.688-0.786). Exploratory analyses were directionally stable, but paired biomarker comparisons did not provide definitive evidence of superiority. Certainty was very low for all major outcomes.

Por que isso importa

Circulating calprotectin and S100A8/A9-related biomarkers provide moderate, context-dependent information in adult acute infection and sepsis. They may serve as adjunctive host-response markers, particularly for selected infection/source contrasts, but current evidence does not support stand-alone diagnosis, universal thresholds, or replacement of established biomarkers and clinical assessment.

Resumo publicado sob licença CC BY. A tradução para o português ainda não chegou a este estudo.