Department of Geriatrics, Helios Clinic Schwelm, Schwelm, Germany.
Online Research Club, Nagasaki, Japan.
PLoS One. 2024 Aug 29;19(8):e0305895. doi: 10.1371/journal.pone.0305895. eCollection 2024.
Sepsis remains a major cause of mortality in intensive care units (ICUs). Prompt diagnosis and effective management are imperative for better outcomes. In this systematic review and meta-analysis, we explore the potential of circulating cell-free DNA (cfDNA), as a promising tool for early sepsis detection and prognosis assessment, aiming to address limitations associated with traditional diagnostic methods.
Following PRISMA guidelines, we collected relevant literature from thirteen databases. Studies were included if they analyzed quantitative diagnostic or prognostic cfDNA levels in humans in case of sepsis. We collected data on basic study characteristics, baseline patient demographics (e.g. age and sex), and cfDNA levels across different stages of sepsis. Pooled SMD with 95%-CI was calculated, and Comprehensive Meta-Analysis (CMA) software facilitated meta-analysis. Receiver operating characteristic (ROC) curves were generated to assess cfDNA's combined sensitivity and specificity in diagnostics and prognostics.
We included a final of 44 studies, of which, only 32 with 2950 participants were included in the meta-analysis. cfDNA levels were higher in septic patients compared to healthy controls (SMD = 3.303; 95%-CI [2.461-4.145], p<0.01). Furthermore, cfDNA levels were higher in non-survivors than survivors (SMD = 1.554; 95%-CI [0.905-2.202], p<0.01). Prognostic studies demonstrated a pooled sensitivity and specificity of 0.78, while diagnostic studies showed a sensitivity of 0.81 and a specificity of 0.87.
These findings show that cfDNA levels are significantly higher in sepsis patients compared to control groups and non-survivors in comparison to survivors among both adult and pediatric populations.
脓毒症仍然是重症监护病房（ICU）患者死亡的主要原因。及时诊断和有效治疗对改善预后至关重要。在本系统评价和荟萃分析中，我们探讨了循环游离 DNA（cfDNA）作为早期脓毒症检测和预后评估的有前途的工具的潜力，旨在解决与传统诊断方法相关的局限性。
根据 PRISMA 指南，我们从 13 个数据库中收集了相关文献。如果研究分析了人类脓毒症中定量诊断或预后 cfDNA 水平，则将其纳入研究。我们收集了基本研究特征、基线患者人口统计学（如年龄和性别）以及不同脓毒症阶段的 cfDNA 水平的数据。使用综合 Meta 分析（CMA）软件计算了合并标准化均数差（SMD）及其 95%置信区间（CI），并绘制了受试者工作特征（ROC）曲线，以评估 cfDNA 在诊断和预后中的综合敏感性和特异性。
我们最终纳入了 44 项研究，其中只有 32 项研究共 2950 名参与者纳入荟萃分析。与健康对照组相比，脓毒症患者的 cfDNA 水平更高（SMD = 3.303；95%CI [2.461-4.145]，p<0.01）。此外，非幸存者的 cfDNA 水平高于幸存者（SMD = 1.554；95%CI [0.905-2.202]，p<0.01）。预后研究的合并敏感性和特异性为 0.78，而诊断研究的敏感性为 0.81，特异性为 0.87。
这些发现表明，cfDNA 水平在成人和儿科人群中，与对照组相比，脓毒症患者的 cfDNA 水平明显更高，与幸存者相比，非幸存者的 cfDNA 水平更高。
