Limits...
Accuracy of plasma sTREM-1 for sepsis diagnosis in systemic inflammatory patients: a systematic review and meta-analysis.

Wu Y, Wang F, Fan X, Bao R, Bo L, Li J, Deng X - Crit Care (2012)

Bottom Line: The area under the curve of the summary receiver operator characteristic was 0.87 (95% CI, 0.84 to 0.89).Meta-regression analysis suggested that patient sample size and assay method were the main sources of heterogeneity.Publication bias was suggested by an asymmetrical funnel plot (P = 0.02).

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: Early diagnosis of sepsis is vital to the clinical course and outcome of septic patients. Recently, soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) appears to be a potential marker of infection. The objective of this systematic review and meta-analysis was to evaluate the accuracy of plasma sTREM-1 for sepsis diagnosis in systemic inflammatory patients.

Methods: A systematic literature search of PubMed, Embase and Cochrane Central Register of Controlled Trials was performed using specific search terms (up to 15 October 2012). Studies were included if they assessed the accuracy of plasma sTREM-1 for sepsis diagnosis in adult patients with systemic inflammatory response syndrome (SIRS) and provided sufficient information to construct a 2 X 2 contingency table.

Results: Eleven studies with a total of 1,795 patients were included. The pooled sensitivity and specificity was 79% (95% confidence interval (CI), 65 to 89) and 80% (95% CI, 69 to 88), respectively. The positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio were 4.0 (95% CI, 2.4 to 6.9), 0.26 (95% CI, 0.14 to 0.48), and 16 (95% CI, 5 to 46), respectively. The area under the curve of the summary receiver operator characteristic was 0.87 (95% CI, 0.84 to 0.89). Meta-regression analysis suggested that patient sample size and assay method were the main sources of heterogeneity. Publication bias was suggested by an asymmetrical funnel plot (P = 0.02).

Conclusions: The present meta-analysis showed that plasma sTREM-1 had a moderate diagnostic performance in differentiating sepsis from SIRS. Accordingly, plasma sTREM-1 as a single marker was not sufficient for sepsis diagnosis in systemic inflammatory patients.

Show MeSH

Related in: MedlinePlus

Study identification, inclusion, and exclusion for meta-analysis. Flow-chart of study selection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3672614&req=5

Figure 1: Study identification, inclusion, and exclusion for meta-analysis. Flow-chart of study selection.

Mentions: The initial search yielded 664 citations, of which 15 publications dealing with sTREM-1 for sepsis diagnosis were considered as potentially suitable for inclusion. After full-text review, seven studies were excluded: three studies were excluded because the reviewers could not generate a 2 X 2 contingency table [37-39], one was excluded because it detected TREM-1 mRNA not sTREM-1 [40], two were excluded because it detected sTREM-1 in bronchoalveolar lavage fluid [41] or urine [12], and one was excluded because it targeted on neonates [42]. Three studies were included in the updated search (15 October 2012) [23-25]. Totally, 11 studies were included for the pooled analysis [9,16-25] (Figure 1). The Cohen Κ statistic for agreement on study inclusion was 0.92.


Accuracy of plasma sTREM-1 for sepsis diagnosis in systemic inflammatory patients: a systematic review and meta-analysis.

Wu Y, Wang F, Fan X, Bao R, Bo L, Li J, Deng X - Crit Care (2012)

Study identification, inclusion, and exclusion for meta-analysis. Flow-chart of study selection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3672614&req=5

Figure 1: Study identification, inclusion, and exclusion for meta-analysis. Flow-chart of study selection.
Mentions: The initial search yielded 664 citations, of which 15 publications dealing with sTREM-1 for sepsis diagnosis were considered as potentially suitable for inclusion. After full-text review, seven studies were excluded: three studies were excluded because the reviewers could not generate a 2 X 2 contingency table [37-39], one was excluded because it detected TREM-1 mRNA not sTREM-1 [40], two were excluded because it detected sTREM-1 in bronchoalveolar lavage fluid [41] or urine [12], and one was excluded because it targeted on neonates [42]. Three studies were included in the updated search (15 October 2012) [23-25]. Totally, 11 studies were included for the pooled analysis [9,16-25] (Figure 1). The Cohen Κ statistic for agreement on study inclusion was 0.92.

Bottom Line: The area under the curve of the summary receiver operator characteristic was 0.87 (95% CI, 0.84 to 0.89).Meta-regression analysis suggested that patient sample size and assay method were the main sources of heterogeneity.Publication bias was suggested by an asymmetrical funnel plot (P = 0.02).

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: Early diagnosis of sepsis is vital to the clinical course and outcome of septic patients. Recently, soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) appears to be a potential marker of infection. The objective of this systematic review and meta-analysis was to evaluate the accuracy of plasma sTREM-1 for sepsis diagnosis in systemic inflammatory patients.

Methods: A systematic literature search of PubMed, Embase and Cochrane Central Register of Controlled Trials was performed using specific search terms (up to 15 October 2012). Studies were included if they assessed the accuracy of plasma sTREM-1 for sepsis diagnosis in adult patients with systemic inflammatory response syndrome (SIRS) and provided sufficient information to construct a 2 X 2 contingency table.

Results: Eleven studies with a total of 1,795 patients were included. The pooled sensitivity and specificity was 79% (95% confidence interval (CI), 65 to 89) and 80% (95% CI, 69 to 88), respectively. The positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio were 4.0 (95% CI, 2.4 to 6.9), 0.26 (95% CI, 0.14 to 0.48), and 16 (95% CI, 5 to 46), respectively. The area under the curve of the summary receiver operator characteristic was 0.87 (95% CI, 0.84 to 0.89). Meta-regression analysis suggested that patient sample size and assay method were the main sources of heterogeneity. Publication bias was suggested by an asymmetrical funnel plot (P = 0.02).

Conclusions: The present meta-analysis showed that plasma sTREM-1 had a moderate diagnostic performance in differentiating sepsis from SIRS. Accordingly, plasma sTREM-1 as a single marker was not sufficient for sepsis diagnosis in systemic inflammatory patients.

Show MeSH
Related in: MedlinePlus