sTREM-1 在 ICU 细菌性肺部感染患者支气管肺泡灌洗液中的诊断价值：二变量荟萃分析。

Diagnostic value of sTREM-1 in bronchoalveolar lavage fluid in ICU patients with bacterial lung infections: a bivariate meta-analysis.

机构信息

Department of Respiratory Medicine, Lianyungang First People's Hospital, Affiliated Hospital of Xuzhou Medical College, Lianyungang, China.

出版信息

PLoS One. 2013 May 29;8(5):e65436. doi: 10.1371/journal.pone.0065436. Print 2013.

BACKGROUND

The serum soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) is a useful biomarker in differentiating bacterial infections from others. However, the diagnostic value of sTREM-1 in bronchoalveolar lavage fluid (BALF) in lung infections has not been well established. We performed a meta-analysis to assess the accuracy of sTREM-1 in BALF for diagnosis of bacterial lung infections in intensive care unit (ICU) patients.

METHODS

We searched PUBMED, EMBASE and Web of Knowledge (from January 1966 to October 2012) databases for relevant studies that reported diagnostic accuracy data of BALF sTREM-1 in the diagnosis of bacterial lung infections in ICU patients. Pooled sensitivity, specificity, and positive and negative likelihood ratios were calculated by a bivariate regression analysis. Measures of accuracy and Q point value (Q*) were calculated using summary receiver operating characteristic (SROC) curve. The potential between-studies heterogeneity was explored by subgroup analysis.

RESULTS

Nine studies were included in the present meta-analysis. Overall, the prevalence was 50.6%; the sensitivity was 0.87 (95% confidence interval (CI), 0.72-0.95); the specificity was 0.79 (95% CI, 0.56-0.92); the positive likelihood ratio (PLR) was 4.18 (95% CI, 1.78-9.86); the negative likelihood ratio (NLR) was 0.16 (95% CI, 0.07-0.36), and the diagnostic odds ratio (DOR) was 25.60 (95% CI, 7.28-89.93). The area under the SROC curve was 0.91 (95% CI, 0.88-0.93), with a Q* of 0.83. Subgroup analysis showed that the assay method and cutoff value influenced the diagnostic accuracy of sTREM-1.

CONCLUSIONS

BALF sTREM-1 is a useful biomarker of bacterial lung infections in ICU patients. Further studies are needed to confirm the optimized cutoff value.

背景

血清可溶性髓系细胞触发受体-1（sTREM-1）是区分细菌性感染与其他感染的有用生物标志物。然而，支气管肺泡灌洗液（BALF）中 sTREM-1 在肺部感染中的诊断价值尚未得到充分证实。我们进行了一项荟萃分析，以评估 BALF 中 sTREM-1 对 ICU 患者细菌性肺部感染的诊断准确性。

方法

我们检索了 PUBMED、EMBASE 和 Web of Knowledge（从 1966 年 1 月至 2012 年 10 月）数据库，以获取报道 ICU 患者细菌性肺部感染中 BALF sTREM-1 诊断准确性数据的相关研究。通过双变量回归分析计算合并敏感性、特异性、阳性和阴性似然比。使用汇总受试者工作特征（SROC）曲线计算准确性和 Q 点值（Q*）。通过亚组分析探讨研究间潜在的异质性。

结果

本荟萃分析共纳入 9 项研究。总体而言，患病率为 50.6%；敏感性为 0.87（95%置信区间（CI），0.72-0.95）；特异性为 0.79（95%CI，0.56-0.92）；阳性似然比（PLR）为 4.18（95%CI，1.78-9.86）；阴性似然比（NLR）为 0.16（95%CI，0.07-0.36），诊断比值比（DOR）为 25.60（95%CI，7.28-89.93）。SROC 曲线下面积为 0.91（95%CI，0.88-0.93），Q*为 0.83。亚组分析显示，检测方法和截断值影响 sTREM-1 的诊断准确性。