Diagnostic value of fecal calprotectin in necrotizing enterocolitis: A meta-analysis

Background and objectives: Necrotizing enterocolitis is a common gastrointestinal disease in newborns, especially in preterm infants. Our study analyzed the value of fecal calprotectin as a biomarker in the diagnosis of NEC based on previous studies that have confirmed elevated calprotectin levels in NEC patients. Method: We searched several databases including PubMed, Medline, Web of Science and Cochrane Library to identify studies of humans investigating the performance characteristics of fecal calprotectin for the diagnosis of NEC. The quality of included studies was assessed by RevMan5 software (QUADAS-2). The sensitivity, specificity and other measurements of accuracy of fecal calprotectin were pooled using Meta-DiSc software. Result: A total 10 studies with 568 patients included in our meta-analysis. The pooled sensitivity, specificity, diagnostic odds ratio (DOR) and AUC were: 0.86 (95%CI: 0.80-0.91), 0.79 (95%CI: 0.75-0.83), 34.78 (95% CI: 15.30 to 79.07) and 0.92. The pooled sensitivity, specificity, DOR and AUC of subgroup analysis were: 0.85 (95%CI: 0.79-0.90), 0.89 (95%CI: 0.85-0.92), 41.03 (95% CI: 16.87 to 99.78) and 0.92 for nine studies using ELISA; 0.85 (95%CI: 0.79-0.90), 0.89 (95%CI: 0.85-0.92), 42.08 (95% CI: 18.44 to 96.04) and 0.93 for six prospective studies; 0.91 (95%CI: 0.82-0.97), 0.93 (95%CI: 0.88-0.96), 69.51 (95% CI: 17.67 to 273.40) and 0.95 for four studies of preterm infants. 0.86 (95%CI: 0.77-0.92), 0.94 (95%CI: 0.90-0.97), 53.23 (95% CI: 15.68 to 180.73) and 0.94 five studies that defined NEC as stage II or above. Conclusion: Fecal calprotectin is a promising biomarker with high diagnostic value in neonatal, especially in premature infants.