{
  "abstract": "Background\n\nPancreatic stone protein (PSP) has been proposed as a prognostic biomarker in sepsis, but its comparative performance versus C-reactive protein (CRP) and procalcitonin (PCT) remains uncertain.Methods\n\nWe performed a meta-analysis of direct within-study paired AUC comparisons between PSP and CRP and/or PCT in critically ill adults with sepsis, septic shock, or acute infection-related conditions in whom sepsis development or clinically relevant adverse outcomes were prospectively evaluated. Differences in AUC (ΔAUC) were pooled using random-effects models. The principal conservative analysis included one comparison per independent cohort and comparator.Results\n\nSeven studies comprising 803 unique participants contributed 21 paired comparisons. In the principal conservative analysis, PSP showed a higher prognostic AUC than CRP, with a pooled ΔAUC of 0.179 (95% CI 0.095-0.262; p < 0.001), although between-cohort heterogeneity was substantial (I² = 81.65%). Compared with PCT, the pooled ΔAUC was 0.153 (95% CI 0.114-0.193; p < 0.001), with no observed heterogeneity (I² = 0.00%). The mortality-only sensitivity analysis showed a similar pooled effect for PSP versus CRP (ΔAUC 0.17, 95% CI 0.08-0.26), with substantial heterogeneity persisting, and for PSP versus PCT (ΔAUC 0.153, 95% CI 0.114-0.193), with no observed heterogeneity. Exclusion of the clinically distinct intra-abdominal infection cohort (Michailides et al.) likewise did not materially change the PSP-versus CRP estimate (ΔAUC 0.166, 95% CI 0.077-0.256). The direction and approximate magnitude of the pooled effects were also preserved across alternative assumptions for the within-study correlation.Conclusions\n\nAvailable comparative evidence suggests that PSP may have greater prognostic discrimination than CRP and PCT. The findings were broadly maintained across sensitivity analyses, but the limited number of independent cohorts and substantial heterogeneity in the CRP comparison warrant caution. Further prospective studies are required to confirm these findings and establish their clinical relevance.Trial registration\n\nThis systematic review was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420261340301).",
  "abstract_shown": true,
  "affiliations": [
    "Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Policlinico di Modena, Via del Pozzo 71, Modena, 41124, Italy. melegari.gabriele@gmail.com.",
    "School of Anesthesia and Intensive Care, University of Modena and Reggio Emilia, Modena, Italy.",
    "Department of Anaesthesia and Intensive Care, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.",
    "Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy.",
    "Department of Cardio-Thoracic Anaesthesia and Intensive Care IRCCS San Raffaele Scientific Institute, Milan, Italy.",
    "Department of Anaesthesia and Intensive Care, ASST Gaetano Pini-CTO, Milan, Italy.",
    "School of Medcine, University of Modena and Reggio Emilia, Modena, Italy."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Gabriele Melegari",
      "orcid": "0000-0003-4512-4835"
    },
    {
      "affs": [
        1
      ],
      "name": "Valerio Valente"
    },
    {
      "affs": [
        1
      ],
      "name": "Federica Arturi"
    },
    {
      "affs": [
        2
      ],
      "name": "Ilaria Pacini"
    },
    {
      "affs": [
        3
      ],
      "name": "Eros Pilia"
    },
    {
      "affs": [
        4
      ],
      "name": "Alessandro Belletti"
    },
    {
      "affs": [
        5
      ],
      "name": "Andrea Tognù"
    },
    {
      "affs": [
        6
      ],
      "name": "Elisabetta Bertellini"
    },
    {
      "affs": [
        1
      ],
      "name": "Alberto Barbieri"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/fkdcqfshssrbn.bib",
  "cited_by": 0,
  "doi": "10.1186/s40635-026-00990-6",
  "fulltext_url": "https://europepmc.org/articles/PMC13683286",
  "id": "fkdcqfshssrbn",
  "issns": [
    "2197-425X"
  ],
  "landing_url": "https://europepmc.org/article/MED/42900319",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RC86-88.9"
    ],
    [
      "openalex",
      "2713|Sepsis Diagnosis and Treatment"
    ]
  ],
  "openalex": "W7223025463",
  "pdf_url": "https://europepmc.org/articles/PMC13683286?pdf=render",
  "pmcid": "PMC13683286",
  "pmid": "42900319",
  "published": "2026-10-20",
  "publisher": "SpringerOpen",
  "ris": "https://research.draconitic.com/paper/fkdcqfshssrbn.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:32Z",
      "native_id": "MED:42900319",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42900319"
    },
    {
      "first_seen": "2026-10-30T13:45:38Z",
      "native_id": "b96892fee15741599d16fc466bf08d95",
      "source": "doaj",
      "url": "https://doi.org/10.1186/s40635-026-00990-6"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Sepsis Diagnosis and Treatment",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Pancreatic stone protein versus conventional biomarkers for prognostic discrimination in sepsis: a meta-analysis of paired AUC comparisons.",
  "title_text": "Pancreatic stone protein versus conventional biomarkers for prognostic discrimination in sepsis: a meta-analysis of paired AUC comparisons.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:45:38Z",
  "url": "https://research.draconitic.com/paper/fkdcqfshssrbn",
  "venue": "Intensive care medicine experimental",
  "versions": []
}