Department of Pulmonary Medicine, Huadong Hospital, Shanghai Medical College, Fudan University, People's Republic of China.
BMC Infect Dis. 2011 Oct 20;11:280. doi: 10.1186/1471-2334-11-280.
Pleural infection is a common clinical problem. Its successful treatment depends on rapid diagnosis and early initiation of antibiotics. The measurement of soluble triggering receptor expressed in myeloid cells-1 (sTREM-1) level in pleural effusions has proven to be a valuable diagnostic tool for differentiating bacterial effusions from effusions of other etiologies. Herein, we performed a meta-analysis to assess the accuracy of pleural fluid sTREM-1 in the diagnosis of bacterial infection.
We searched Web of Knowledge and Medline from 1990 through March 2011 for studies reporting diagnostic accuracy data regarding the use of sTREM-1 in the diagnosis of bacterial pleural effusions. Pooled sensitivity and specificity and summary measures of accuracy and Q* were calculated.
Overall, the sensitivity of sTREM-1was 78% (95% CI: 72%-83%); the specificity was 84% (95% CI: 80%-87%); the positive likelihood ratio was 6.0 (95% CI: 3.3-10.7); and the negative likelihood ratio was 0.22 (95% CI: 0.12-0.40). The area under the SROC curve for sTREM-1 was 0.92. Statistical heterogeneity and inconsistency were found for sensitivity (p = 0.015, χ2 = 15.73, I2 = 61.9%), specificity (p = 0.000, χ2 = 29.90, I2 = 79.9%), positive likelihood ratio (p = 0.000, χ2 = 33.09, I2 = 81.9%), negative likelihood ratio (p = 0.008, χ2 = 17.25, I2 = 65.2%), and diagnostic odds ratio (p = 0.000, χ2 = 28.49, I2 = 78.9%). A meta-regression analysis performed showed that the Quality Assessment of Diagnostic Accuracy Studies score (p = 0.3245; RDOR, 4.34; 95% CI, 0.11 to 164.01), the Standards for Reporting of Diagnostic Accuracy score (p = 0.3331; RDOR, 1.70; 95% CI, 0.44 to 6.52), lack of blinding (p = 0.7439; RDOR, 0.60; 95% CI, 0.01 to 33.80), and whether the studies were prospective or retrospective studies (p = 0.2068; RDOR, 7.44; 95% CI, 0.18 to 301.17) did not affect the test accuracy. A funnel plot for publication bias suggested a remarkable trend of publication bias.
Our findings suggest that sTREM-1 has a good diagnostic accuracy and may provide a useful adjunctive tool for the diagnosis of bacterial pleural effusions. However, further studies are needed in order to identify any differences in the diagnostic performance of sTREM-1 of parapneumonic effusions and empyemas.
胸腔感染是一种常见的临床问题。其成功治疗取决于快速诊断和早期使用抗生素。胸腔积液中可溶性髓系细胞触发受体-1（sTREM-1）水平的测量已被证明是区分细菌性胸腔积液和其他病因胸腔积液的有价值的诊断工具。在此，我们进行了一项荟萃分析，以评估胸腔积液 sTREM-1 在诊断细菌性感染中的准确性。
我们检索了 Web of Knowledge 和 Medline 从 1990 年到 2011 年 3 月发表的关于 sTREM-1 用于诊断细菌性胸腔积液的诊断准确性数据的研究报告。计算了合并敏感性和特异性、准确性和 Q*的综合指标。
总体而言，sTREM-1 的敏感性为 78%（95%CI：72%-83%）；特异性为 84%（95%CI：80%-87%）；阳性似然比为 6.0（95%CI：3.3-10.7）；阴性似然比为 0.22（95%CI：0.12-0.40）。sTREM-1 的 SROC 曲线下面积为 0.92。敏感性（p=0.015，χ2=15.73，I2=61.9%）、特异性（p=0.000，χ2=29.90，I2=79.9%）、阳性似然比（p=0.000，χ2=33.09，I2=81.9%）、阴性似然比（p=0.008，χ2=17.25，I2=65.2%）和诊断比值比（p=0.000，χ2=28.49，I2=78.9%）存在统计学异质性和不一致性。进行的荟萃回归分析显示，诊断准确性研究质量评估评分（p=0.3245；RDOR，4.34；95%CI，0.11 至 164.01）、诊断准确性报告标准评分（p=0.3331；RDOR，1.70；95%CI，0.44 至 6.52）、缺乏盲法（p=0.7439；RDOR，0.60；95%CI，0.01 至 33.80）和研究是否为前瞻性或回顾性研究（p=0.2068；RDOR，7.44；95%CI，0.18 至 301.17）均未影响测试准确性。发表偏倚的漏斗图表明存在显著的发表偏倚趋势。
我们的研究结果表明，sTREM-1 具有良好的诊断准确性，可能为细菌性胸腔积液的诊断提供有用的辅助工具。然而，需要进一步的研究来确定 sTREM-1 在类肺炎性胸腔积液和脓胸中的诊断性能是否存在差异。
