Hagens Laura A, Heijnen Nanon F L, Smit Marry R, Schultz Marcus J, Bergmans Dennis C J J, Schnabel Ronny M, Bos Lieuwe D J
Dept of Intensive Care, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands.
Dept of Intensive Care, Maastricht University Medical Centre+, Maastricht, The Netherlands.
ERJ Open Res. 2021 Jan 18;7(1). doi: 10.1183/23120541.00504-2020. eCollection 2021 Jan.
Acute respiratory distress syndrome (ARDS) is currently diagnosed by the Berlin definition, which does not include a direct measure of pulmonary oedema, endothelial permeability or pulmonary inflammation. We hypothesised that biomarkers of these processes have good diagnostic accuracy for ARDS.
Medline and Scopus were searched for original diagnostic studies using minimally invasive testing. Primary outcome was the diagnostic accuracy per test and was categorised by control group. The methodological quality was assessed with QUADAS-2 tool. Biomarkers that had an area under the receiver operating characteristic curve (AUROCC) of >0.75 and were studied with minimal bias against an unselected control group were considered to be promising.
Forty-four articles were included. The median AUROCC for all evaluated tests was 0.80 (25th to 75th percentile: 0.72-0.88). The type of control group influenced the diagnostic accuracy (p=0.0095). Higher risk of bias was associated with higher diagnostic accuracy (AUROCC 0.75 for low-bias, 0.77 for intermediate-bias and 0.84 for high-bias studies; p=0.0023). Club cell protein 16 and soluble receptor for advanced glycation end-products in plasma and two panels with biomarkers of oxidative stress in breath showed good diagnostic accuracy in low-bias studies that compared ARDS patients to an unselected intensive care unit (ICU) population.
This systematic review revealed only four diagnostic tests fulfilling stringent criteria for a promising biomarker in a low-bias setting. For implementation into the clinical setting, prospective studies in a general unselected ICU population with good methodological quality are needed.
急性呼吸窘迫综合征（ARDS）目前依据柏林定义进行诊断，该定义未纳入肺水肿、内皮通透性或肺部炎症的直接测量指标。我们推测这些过程的生物标志物对ARDS具有良好的诊断准确性。
检索Medline和Scopus数据库，查找使用微创检测的原始诊断研究。主要结局是每项检测的诊断准确性，并按对照组进行分类。采用QUADAS-2工具评估方法学质量。将接受者操作特征曲线下面积（AUROCC）>0.75且针对未选择的对照组进行研究时偏差最小的生物标志物视为有前景的标志物。
纳入44篇文章。所有评估检测的AUROCC中位数为0.80（第25至75百分位数：0.72 - 0.88）。对照组类型影响诊断准确性（p = 0.0095）。较高的偏倚风险与较高的诊断准确性相关（低偏倚研究的AUROCC为0.75，中等偏倚研究为0.77，高偏倚研究为0.84；p = 0.0023）。血浆中的克拉拉细胞蛋白16和晚期糖基化终产物可溶性受体以及两组呼吸中氧化应激生物标志物在将ARDS患者与未选择的重症监护病房（ICU）人群进行比较的低偏倚研究中显示出良好的诊断准确性。
本系统评价仅发现四项诊断检测在低偏倚情况下符合有前景生物标志物的严格标准。要将其应用于临床环境，需要在方法学质量良好的一般未选择ICU人群中进行前瞻性研究。
