Medicina de precisión para el diagnóstico de sepsis neonatal: Revisión sistemática y metaanálisis

Abstract

Background: Current biomarkers for the diagnosis of neonatal sepsis have limited accuracy. The development of precision medicine based on omic´s technologies offer an opportunity to improve the diagnosis of neonatal sepsis. Aim: To evaluate the sensitivity and specificity of tests based on omic technologies (metabolomics, proteomics and genomics) for the diagnosis of neonatal sepsis. Methods: A systematic review was carried out in electronic databases. Observational studies and clinical trials evaluating tests based on omic technologies in neonates compared to culture for the diagnosis of neonatal sepsis were included. For the meta-analysis, a random effects model and an evaluation of heterogeneity were proposed through a subgroup analysis by omic test, gestational age and time of establishment of sepsis. Results: Differential expression of the genome, proteome and metabolome is observed between neonates with and without sepsis, identifying different biomarkers. The meta-analysis showed a pooled summary measure for sensitivity of 0.88 (95% CI 0.72, 0.96), specificity of 0.76 (95% CI 0.62, 0.85). Conclusion: Omics-based tests have a high sensitivity, with the best performing ones being those based on genomics/ transcriptomics. The studies have high heterogeneity.