The following is a summary of “Prognostic differences in sepsis caused by gram-negative bacteria and gram-positive bacteria: a systematic review and meta-analysis,” published in the November 2023 issue of Critical Care by Tang et al.
Researchers conducted a systematic review and meta-analysis to compare the predictive differences in sepsis caused by gram-negative and gram-positive bacteria.
They searched the PubMed, Web of Science, Cochrane Library, and Embase databases for Chinese and English studies (January 2003 to September 2023). Inclusion criteria involved observational studies on gram-negative (G (−))/gram-positive (G (+)) bacterial infection and sepsis prognosis. Sensitivity analysis assessed result stability. Publication bias and heterogeneity were evaluated using funnel plots, Egger tests, and meta-regression analysis.
The results showed 6,949 articles, with 45 studies (5,586 subjects) meeting Preferred Reporting Items for Systematic Reviews and meta-analysis guidelines. Based on Newcastle‒Ottawa Scale scores, 27 high-quality and 18 moderate-quality studies were identified. Survival rates did not significantly differ between G (−) and G (+) bacterial sepsis (OR 0.95, 95% CI 0.70–1.28). Subgroup analysis by follow-up time revealed no significant differences. Serum concentrations of C-reactive protein (CRP), procalcitonin, and tumor necrosis factor-alpha (TNF-α) were higher in G (−) bacterial infection (CRP: SMD = 0.39, 95% CI 0.02–0.76; procalcitonin: SMD = 1.95, 95% CI 1.32–2.59; TNF-α: MD = 0.31, 95% CI 0.25–0.38), but no significant differences in IL-6 (SMD = 1.33, 95% CI − 0.18–2.84) and WBC count (MD = − 0.15, 95% CI − 0.96–00.66). No significant differences were found in D dimer level, activated partial thromboplastin time, thrombin time, international normalized ratio, platelet count, length of stay, or ICU stay between G (−) and G (+) bacteria. Sensitivity analysis confirmed the result stability.
Investigators concluded that sepsis caused by G (-) bacteria was associated with higher severity and inflammatory markers but similar outcomes to G (+) sepsis.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-023-04750-w
