Research Article: The role of group IIA secretory phospholipase A2 (sPLA2-IIA) as a biomarker for the diagnosis of sepsis and bacterial infection in adults—A systematic review

Date Published: July 3, 2017

Publisher: Public Library of Science

Author(s): Toh Leong Tan, Yew Yip Goh, Eliseo A Eugenin.

http://doi.org/10.1371/journal.pone.0180554

Abstract

This paper investigates the role of Group II Secretory Phospholipase A2 (sPLA2-IIA) as a biomarker for the diagnosis of sepsis and bacterial infection in adults. Sepsis and bacterial infection are common problems encountered by patients in the hospital and often carry adverse outcomes if not managed early.

Two independent reviewers conducted a comprehensive search using Ovid MEDLINE published from years 1993 to 2016 and SCOPUS published from year 1985 to 2017 to screen for relevant studies. The main inclusion criteria included adult subjects, patients with suspected or confirmed signs of infection and relevant outcomes which looked into the role of sPLA2-IIA in detecting the presence of sepsis and bacterial infection in the subjects.

Four studies met the inclusion criteria. SPLA2-IIA was found to be effective in detecting the presence of sepsis and bacterial infection in adults. The levels of serum sPLA2-IIA also correlated well with the presence of sepsis and bacterial infection.

This systematic review highlights the role of sPLA2-IIA as a reliable tool to diagnose sepsis and bacterial infection in adult patients. Nonetheless, further studies should be done in the future to provide more compelling evidence on its application in the clinical setting.

Partial Text

Sepsis and bacterial infection are common problems encountered by patients in the hospital. Sepsis carries a poor outcome in terms of mortality and long-term morbidity. Severe sepsis is accountable for one-fifth of all admissions to intensive care units (ICUs) in the United States and contributes to the greatest number of non-cardiac-ICU related deaths[1, 2], despite advances in resuscitation therapy and the use of modern antibiotics [3]. Survivals of sepsis suffer from various complications that arise from organ dysfunction, which leads to severe impairment in their quality of life. The key to sepsis management relies on prompt and accurate diagnosis, as every hour of delay of the appropriate antibiotics has been found to increase mortality by 5 to 10%[3]. Blood culture as the current gold standard in detecting sepsis is a laborious and time-consuming effort which may take up to 48 hours before results are made available. The invariable chances of contaminated specimens and incomplete samples further undermine its feasibility as a rapid and convenient tool in the detection and early recognition of sepsis. Apart from that, only 30–60% of blood cultures will be positive in sepsis and this has led to great levels of diagnostic uncertainty among physicians in the early phases of intervention [4–6]. Thus, it is unsurprising that the constant effort in discovering the most reliable sepsis biomarker has become the focus of intensive research over the past decade. Nonetheless, as patients may develop systemic inflammatory response syndrome (SIRS) for various non-septic reasons, the effort of identifying sepsis accurately from this vast pool of patients remains a challenging task. It is this dilemma that has essentially driven the extensive use of empirical antibiotics, giving rise to the emergence of antimicrobial resistance which is fast becoming a major concern worldwide.

This review was systematically done to examine the role of sPLA2-IIA as a biomarker in detecting sepsis and bacterial infection in adults. All 4 studies in this review demonstrated positive correlation between the level of sPLA2-IIA and the presence of sepsis and bacterial infection.

This systematic review highlights the role of sPLA2-IIA as a biomarker for the detection of sepsis and bacterial infection in adults. We conclude that sPLA2-IIA is capable of diagnosing both the aforementioned conditions in adult patients. When used in tandem with other conventional biomarkers such as Lactate[49, 50], CRP[51] and PCT[52, 53], a synergistic effect could be achieved in terms of greater diagnostic sensitivity and specificity as portrayed in the reviewed studies. Besides, the values of serum sPLA2-IIA were found to correlate with the types of infection as well as the severity of sepsis. This substantiates its role as an effective risk-stratifying tool to predict sepsis outcomes in patients. Thus, we suggest that sPLA2-IIA could be potentially applied in the clinical setting to aid physicians in their decision making for early administration of antimicrobial therapy. Nevertheless, we suggest that more studies should be reviewed to yield greater statistical value of the role of sPLA2-IIA in the future.

 

Source:

http://doi.org/10.1371/journal.pone.0180554

 

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