Early diagnostic accuracy of immature platelet fraction for sepsis: a systematic review and meta-analysis

Background The immature platelet fraction, a rapid and accessible indicator of bone marrow thrombopoietic activity, is considered a possible biomarker for the early diagnosis of sepsis. This study aims to evaluate the diagnostic precision of immature platelet fraction testing for the early identification of sepsis. This is, to our knowledge, the first systematic review and meta-analysis addressing this problem. Methods A literature search was carried out on the PubMed and Scopus databases from August 1 to August 8, 2025. Studies that met the inclusion criteria were analyzed to calculate sensitivity, specificity, diagnostic odds ratio, Deeks’ funnel plot, and summary receiver operating characteristic. Sub-group analysis was carried out to evaluate differences in immature platelet fraction diagnostic performance in adults excluding pediatrics data. Results Three studies published between 2013 and 2021 satisfied the selection criteria and were incorporated into the analysis. Meta-analysis indicates that the immature platelet fraction possesses moderate diagnostic accuracy for identifying sepsis. The pooled sensitivity was 74% (95% CI: 53%–87%), and the pooled specificity was 70% (95% CI: 48%–85%). The combined diagnostic odds ratio was 6.54 (95% CI: 2.90–14.76). Moderate heterogeneity was observed between the included studies (I 2 = 59.57%; τ 2 = 0.30). Conclusions Immature platelet fraction may represent a complementary biomarker for sepsis, but limited evidence and methodological heterogeneity necessitate cautious interpretation as these pooled estimates were derived from a limited number of studies. Further standardized prospective studies are required to establish its clinical utility.