Stengel Dirk, Bauwens Kai, Keh Didier, Gerlach Herwig, Ekkernkamp Axel, Tauber Rudolf, Kerner Thoralf
Clinical Epidemiology Division, Department of Orthopedic and Trauma Surgery, Unfallkrankenhaus Berlin, 12683 Berlin, Germany.
Clin Chem. 2005 Jan;51(1):16-24. doi: 10.1373/clinchem.2004.040097. Epub 2004 Nov 18.
After severe trauma, decreased plasma concentrations of the soluble adhesion molecule L-selectin (sCD62L) have been linked to an increased incidence of lung failure and multiorgan dysfunction syndrome (MODS). Individual studies have had conflicting results, however. We examined multiple studies in an attempt to determine whether early sCD62L concentrations are predictive of major complications after severe trauma.
We performed a systematic review of six electronic databases and a manual search for clinical studies comparing outcomes of multiply injured patients (Injury Severity Score > or =16) depending on their early sCD62L blood concentrations. Because of various outcome definitions, acute lung injury (ALI) and adult respiratory distress syndrome (ARDS) were studied as a composite endpoint. Weighted mean differences (WMDs) in sCD62L concentrations were calculated between individuals with and without complications by fixed- and random-effects models.
Altogether, 3370 citations were identified. Seven prospective studies including 350 patients were eligible for data synthesis. Published data showed the discriminatory features of sCD62L but did not allow for calculation of measures of test accuracy. Three of four studies showed lower early sCD62L concentrations among individuals progressing to ALI and ARDS (WMD = -229 microg/L; 95% confidence interval, -476 to 18 microg/L). No differences in sCD62L concentrations were noted among patients with or without later MODS. Nonsurvivors had significantly lower early sCD62L plasma concentrations (WMD = 121 microg/L; 95% confidence interval, 63-179 microg/L), but little information was available on potential confounders in this group.
Early decreased soluble L-selectin concentrations after multiple trauma may signal an increased likelihood of lung injury and ARDS. The findings of this metaanalysis warrant a large cohort study to develop selectin-based models targeting the risk of inflammatory complications.
严重创伤后，可溶性黏附分子L-选择素（sCD62L）的血浆浓度降低与肺功能衰竭和多器官功能障碍综合征（MODS）的发病率增加有关。然而，个别研究结果相互矛盾。我们对多项研究进行了分析，以确定早期sCD62L浓度是否可预测严重创伤后的主要并发症。
我们对六个电子数据库进行了系统综述，并手动检索了临床研究，比较了多发伤患者（损伤严重度评分≥16）根据其早期sCD62L血浓度的预后情况。由于结局定义各异，急性肺损伤（ALI）和成人呼吸窘迫综合征（ARDS）被作为一个复合终点进行研究。采用固定效应模型和随机效应模型计算有并发症和无并发症个体之间sCD62L浓度的加权平均差异（WMD）。
共识别出3370条引文。七项前瞻性研究（包括350例患者）符合数据合成条件。已发表的数据显示了sCD62L的鉴别特征，但无法计算测试准确性的指标。四项研究中的三项显示，进展为ALI和ARDS的个体早期sCD62L浓度较低（WMD = -229μg/L；95%置信区间，-476至18μg/L）。有或无后期MODS的患者之间sCD62L浓度无差异。非幸存者早期血浆sCD62L浓度显著较低（WMD = 121μg/L；95%置信区间，63 - 179μg/L），但该组中关于潜在混杂因素的信息很少。
多发伤后早期可溶性L-选择素浓度降低可能预示肺损伤和ARDS的可能性增加。这项荟萃分析的结果值得进行一项大型队列研究，以开发基于选择素的模型来预测炎症并发症的风险。
