Pancreatic stone protein versus conventional biomarkers for prognostic discrimination in sepsis: a meta-analysis of paired AUC comparisons.
7 affiliations
- 1Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Policlinico di Modena, Via del Pozzo 71, Modena, 41124, Italy. [email protected].
- 2School of Anesthesia and Intensive Care, University of Modena and Reggio Emilia, Modena, Italy.
- 3Department of Anaesthesia and Intensive Care, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
- 4Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy.
- 5Department of Cardio-Thoracic Anaesthesia and Intensive Care IRCCS San Raffaele Scientific Institute, Milan, Italy.
- 6Department of Anaesthesia and Intensive Care, ASST Gaetano Pini-CTO, Milan, Italy.
- 7School of Medcine, University of Modena and Reggio Emilia, Modena, Italy.
Abstract
Background
Pancreatic 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
We 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
Seven 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
Available 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
This systematic review was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420261340301).
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BibTeX
@article{melegari2026pancreatic,
title = {{Pancreatic stone protein versus conventional biomarkers for prognostic discrimination in sepsis: a meta-analysis of paired AUC comparisons.}},
author = {Gabriele Melegari and Valerio Valente and Federica Arturi and Ilaria Pacini and Eros Pilia and Alessandro Belletti and Andrea Tognù and Elisabetta Bertellini and Alberto Barbieri},
journal = {Intensive care medicine experimental},
year = {2026},
month = oct,
doi = {10.1186/s40635-026-00990-6},
url = {https://europepmc.org/article/MED/42900319},
note = {CC BY},
}
RIS
TY - JOUR
TI - Pancreatic stone protein versus conventional biomarkers for prognostic discrimination in sepsis: a meta-analysis of paired AUC comparisons.
AU - Gabriele Melegari
AU - Valerio Valente
AU - Federica Arturi
AU - Ilaria Pacini
AU - Eros Pilia
AU - Alessandro Belletti
AU - Andrea Tognù
AU - Elisabetta Bertellini
AU - Alberto Barbieri
PY - 2026
DA - 2026/10/20
JO - Intensive care medicine experimental
DO - 10.1186/s40635-026-00990-6
UR - https://europepmc.org/article/MED/42900319
AB - Background Pancreatic 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 We 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 Seven 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 Available 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 This systematic review was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420261340301).
SN - 2197-425X
ER -