Howroyd Fiona, Sardeli Amanda Veiga, Smith Fang Gao, Veenith Tonny, Duggal Niharika A, Ahmed Zubair
Department of Inflammation and Ageing, School of Infection, Inflammation and Immunology, College of Medicine and Health, University of Birmingham, Birmingham, UK.
Critical Care Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
J Intensive Care Soc. 2025 Jun 13:17511437251344068. doi: 10.1177/17511437251344068.
Major trauma is a significant global health issue. Pneumonia poses an additional risk for morbidity and mortality after major trauma yet identifying pneumonia remains challenging in clinical practice. This systematic review aims to evaluate blood-based biomarkers for pneumonia in major trauma patients.
The search was performed across four databases up to November 18th 2024, including primary studies investigating blood-based biomarkers associated with pneumonia in adults hospitalised after major trauma (PROSPERO CRD42024542059). Risk of bias was assessed using the ROBINS-E tool and meta-analysis was performed of pooled data.
Among 20 included studies, with a total of 4316 participants, the pooled mean pneumonia rate was 32.7% (23.5%-43.4%). Seventy biomarkers for post-operative pneumonia were identified, with meta-analysis possible for 12 of the reported biomarkers. At admission interleukin (IL)-6 (standardised mean difference: 1.41 (0.04-2.77), = 0.04), cytokeratin fragment 21-1 (CYFRA21-1; 0.53 (0.19-0.86), = 0.002) and leucocyte count (0.28 (0.05-0.50), = 0.01) were higher in patients who developed pneumonia. During hospitalisation, patients with pneumonia had significantly higher IL-10 (4.42 (3.89-4.95), > 0.001) and neutrophil oxidative burst capacity (1.52 (0.96-2.09), > 0.001) at day 1, CYFRA21-1 at day 2 (0.43 (0.10-0.76), = 0.01), IL-6 at day 3 (3.11 (2.66-3.55), > 0.001) and day 5 (0.57 (0.05-1.09), = 0.03) and CRP at day 4 (1.87 (1.51-2.24), > 0.001), day 5 (1.38 (1.03-1.72), > 0.001), day 6 (0.74 (0.42-1.06), > 0.001) and day 7 (0.87 (0.12-1.63), = 0.02). Across the included studies, 85% exhibited some concerns to very high risk of bias.
While we identified potential candidate biomarkers for pneumonia in major trauma patients, the high heterogeneity across trauma populations, clinical diagnostic tools and biomarker testing methods warrants further high-quality studies to confirm their clinical value.
严重创伤是一个重大的全球健康问题。肺炎会增加严重创伤后发病和死亡的风险，但在临床实践中识别肺炎仍然具有挑战性。本系统评价旨在评估严重创伤患者中基于血液的肺炎生物标志物。
截至2024年11月18日，在四个数据库中进行了检索，包括调查严重创伤后住院成人中与肺炎相关的基于血液的生物标志物的原始研究（国际前瞻性系统评价注册库编号CRD42024542059）。使用ROBINS-E工具评估偏倚风险，并对汇总数据进行荟萃分析。
在纳入的20项研究中，共有4316名参与者，汇总的平均肺炎发生率为32.7%（23.5%-43.4%）。确定了70种术后肺炎生物标志物，其中12种报告的生物标志物可以进行荟萃分析。入院时，发生肺炎的患者白细胞介素（IL）-6（标准化均值差：1.41（0.04-2.77），P = 0.04）、细胞角蛋白片段21-1（CYFRA21-1；0.53（0.19-0.86），P = 0.002）和白细胞计数（0.28（0.05-0.50），P = 0.01）较高。住院期间，肺炎患者在第1天IL-10（4.42（3.89-4.95），P>0.001）和中性粒细胞氧化爆发能力（1.52（0.96-2.09），P>0.001）显著升高，第2天CYFRA21-1（0.43（0.10-0.76），P = 0.01），第3天IL-6（3.11（2.66-3.55），P>0.001）和第5天（0.57（0.05-1.09），P = 0.03），第4天CRP（1.87（1.51-2.24），P>0.001），第5天（1.38（1.03-1.72），P>0.001），第6天（0.74（0.42-1.06），P>0.001）和第7天（0.87（0.12-1.63），P = 0.02）升高。在纳入的研究中，85%表现出一些偏倚担忧至非常高的偏倚风险。
虽然我们确定了严重创伤患者中肺炎的潜在候选生物标志物，但创伤人群、临床诊断工具和生物标志物检测方法之间的高度异质性需要进一步的高质量研究来确认它们的临床价值。
