Diagnostic and prognostic value of heparin-binding protein in sepsis: A systematic review and meta-analysis.

BACKGROUND: Sepsis remains a leading cause of death worldwide. In this context, heparin-binding protein (HBP) has emerged as a possible biomarker, drawing significant attention for its diagnostic and prognostic usefulness in septic patients. Despite this advancement, the literature yields conflicting results. This study is intended to critically evaluate the diagnostic and prognostic value of HBP in critically ill septic patients. METHODS: We searched multiple databases, including PubMed, SCOPUS, Web of Science, and EBSCO, to identify relevant studies on April 27, 2023. We included studies investigating sepsis or its severe outcomes that reported HBP levels and the required data to create 2 × 2 tables. We used R version 4.2.2 and R Studio to analyze the pooled diagnostic accuracy outcomes. The diagmeta package was utilized to calculate the optimum cutoff value. RESULTS: In our meta-analysis, we incorporated 28 studies including 5508 patients. The analysis revealed that HBP has a sensitivity of 0.71 (95% CI: 0.60; 0.79) and a specificity of 0.68 (95% CI: 0.51; 0.81) in diagnosing sepsis, respectively. HBP demonstrated moderate prognostic accuracy for mortality at a cutoff value of 161.415 ng/mL, with a sensitivity and specificity of 72%, and for severe sepsis outcomes at a cutoff value of 58.907 ng/mL, with a sensitivity and specificity of 71%. CONCLUSION: Our findings indicate a relatively moderate diagnostic and prognostic accuracy of HBP for sepsis. Future studies are required to verify the accuracy of HBP as a biomarker for sepsis.

The diagnostic utility of heparin-binding protein among patients with bacterial infections: a systematic review and meta-analysis.

BACKGROUND: Bacterial infections are considered a leading cause of hospitalization and death globally. There is still a need for a rapid and feasible biomarker for bacterial infections. Heparin-binding protein (HBP) was shown to be related to bacterial infections. The objective of the study is to investigate the diagnostic accuracy of HBP in bacterial infections. METHODS: Articles were screened in PubMed, SCOPUS, Web of Science, and Cochrane to recognize eligible studies. We included studies investigating the diagnostic accuracy of HBP and reported the necessary data to construct 2 × 2 tables. A univariate analysis was conducted to determine the pooled sensitivity and specificity, and a bivariate diagnostic random-effects model was used to calculate the optimal cut-off point. RESULTS: The analysis comprised sixteen studies in total. Plasma HBP showed a sensitivity of 0.90 (95% CI: [0.79, 0.96]) and a specificity of 0.87 (95% CI: [0.66, 0.96]) in diagnosing bacterial infections using blood samples. Pooling data from seven studies revealed that HBP in cerebrospinal fluid (CSF) has sensitivity and specificity of 96% (95% CI: [0.85, 0.99]), and 95% (95% CI: [0.89, 0.97]), respectively, for the diagnosis of bacterial meningitis. In urinary tract infections (UTI), urine-HBP was revealed to have a high diagnostic value in discriminating bacterial from non-bacterial UTI infection at a cut-off value of 32.868 ng/ml with sensitivity and specificity of 87%. CONCLUSION: HBP has shown a high diagnostic accuracy of bacterial infections, including UTI and meningitis. Further studies are needed to determine its prognostic value and whether it could guide antibiotic therapy.

Efficacy and Safety of Extensive Intraperitoneal Lavage for Patients with Gastric Cancer - A Systematic Review and Meta-analysis.

PURPOSE: Extensive intraperitoneal lavage (EIPL) is a novel therapeutic intervention that aims to limit the chance of peritoneal metastasis during gastrectomy. Clinical trials on using EIPL after gastrectomy show controversial results. We aimed to summarize the evidence of efficacy and safety for using EIPL after gastrectomy to limit the possibility of peritoneal metastasis and improve survival. METHODS: A literature search on PubMed, Scopus, Embase, and Web of Sciences was conducted till June 2023 to identify eligible RCTs that assess the efficacy and safety of EIPL after gastrectomy. The hazard ratio with 95% CI was used to determine the survival probability, the risk ratio with 95% CI was used to assess the surgical outcomes, and ROB-2 and GRADE guidelines were used to assess the risk of bias and the certainty of evidence respectively. RESULTS: Six eligible studies with a total of 1993 patients were included in the meta-analysis. Regarding survival benefits, the survival of the EIPL group did not differ significantly from the non-EIPL group, and the pooled HR of overall survival was 0.86 (95% CI 0.58-1.26) P = 0.44, the disease-free survival was 0.81 (0.58-1.13) P = 0.21, and peritoneal recurrence-free survival was 0.97 (0.79-1.2) P = 0.25. There is no significant association between EIPL and short-term postoperative outcomes. The use of EIPL does not appear to affect postoperative mortality, infection, anastomotic leakage, bleeding, ileus, or hospital stay. CONCLUSION: Our study yielded insufficient evidence about the survival benefits and surgical outcomes of EIPL in patients with gastric cancer after gastrectomy. Therefore, it is not recommended for treating gastric cancer patients.

Knowledge, attitude, and acceptance of healthcare workers and the public regarding the COVID-19 vaccine: a cross-sectional study.

BACKGROUND: This study determined the knowledge, attitudes, and practice regarding COVID-19 and assessed the acceptance of the COVID-19 vaccine among healthcare workers and the general population. METHODS: A web-based, cross-sectional study was conducted using convenience sampling in Libya from December 1 to 18, 2020 among the general population and healthcare workers. Data on demographic characteristics, COVID-19 vaccination-related concerns, knowledge, attitudes, and practice regarding COVID-19, and knowledge, attitudes, and acceptance regarding the COVID-19 vaccine were collected using a self-administered survey. A binomial logistic regression was performed with 70% efficacy to determine the association between acceptance of the vaccine and study variables. RESULTS: Valid and complete responses were collected from 15,087 participants. Of these, 6227 (41.3%) were male and 8860 (58.7%) were female, with a mean (SD) age of 30.6 ± 9.8 years. Moreover, 485 (3.2%) participants were infected with COVID-19 at the time of the study, while 2000 (13.3%) had been previously infected. Overall, 2452 (16.3%) participants agreed, and 3127 (20.7%) strongly agreed, with "having concerns about serious vaccine-related complications." Mask-wearing adherence was reported by 10,268 (68.1%) of the participants. Most participants (14,050, 93.1%) believed that the vaccine should be provided for free, while 7272 (48.2%) were willing to buy it. Regarding vaccine acceptance and efficacy, 12,006 (79.6%) reported their willingness to take the vaccine with an efficacy of 90% or more, 9143 (60.6%) with an efficacy of 70% or more, and only 6212 (41.2%) with an efficacy of 50%. The binomial logistic regression revealed that vaccine acceptance was not associated with belonging to the medical field versus the general population. Acceptance was statistically associated with younger age groups, especially 31-40 (OR = 1.3 [1.09, 1.55]) and 41-50 years (OR = 1.29, [1.09, 1.54]). However, having a family member or friend infected with COVID-19 was positively associated with the likelihood of vaccine acceptance (OR = 1.09 [1.02, 1.18]), while having a friend or family member who died due to COVID-19 was negatively associated with it (OR = 0.89 [0.84, 0.97]). CONCLUSIONS: Acceptance of the COVID-19 vaccine is an essential determinant of vaccine uptake and the likelihood of controlling the COVID-19 pandemic. Developing strategies to decrease public hesitation and increase trust is vital for implementing vaccination programs.