Meta-analysis of serum amyloid A for the diagnosis of neonatal sepsis: A comprehensive evaluation of diagnostic accuracy and clinical utility.

Abstract

<h4>Background</h4>Neonatal sepsis remains a major clinical challenge due to its high morbidity and mortality, necessitating reliable diagnostic markers for early detection. This meta-analysis evaluates the potential of serum amyloid A (SAA) as a diagnostic biomarker for neonatal sepsis, given its role in the acute inflammatory response.<h4>Methods</h4>Computerized searches of PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, VIP Database, and China Biology Medicine disc (CBM) were conducted to collect relevant studies on the diagnostic role of SAA in neonatal sepsis. Literature screening, data extraction, and quality assessment of studies were performed according to inclusion and exclusion criteria and QUADAS standards. Data analysis was conducted using Stata 17.0 and Meta-Disc 1.4 software. Stata 17.0 was used to calculate the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of included studies, and to draw forest plots and summary receiver operating characteristic (SROC) curves. The area under the SROC curve was calculated, and a funnel plot was constructed to assess publication bias.<h4>Results</h4>A total of 16 articles, comprising 971 neonates with sepsis, were included. Meta-analysis results showed that the combined sensitivity and specificity of SAA in diagnosing neonatal sepsis were 0.85 (95% CI: 0.79-0.89) and 0.86 (95% CI: 0.77-0.92), respectively. The combined positive likelihood ratio and negative likelihood ratio were 6.3 (95% CI: 3.6-10.9) and 0.18 (95% CI: 0.12-0.25), respectively, and the diagnostic odds ratio was 36 (95% CI: 16-79). The area under the curve of the SROC curve was 0.91, and the Deek funnel plot suggested no publication bias in the included studies.<h4>Conclusion</h4>SAA has high sensitivity and specificity in diagnosing neonatal sepsis, providing important evidence for its treatment. However, there is considerable heterogeneity among different studies, and further high-quality prospective studies are needed to confirm its clinical applicability.