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Meta-Analysis
. 2012 Nov 29;16(6):R229.
doi: 10.1186/cc11884.

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

Youping Wu, Fei Wang, Xiaohua Fan, Rui Bao, Lulong Bo, Jinbao Li, Xiaoming Deng
Meta-Analysis

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

Youping Wu et al. Crit Care. .

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.

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Figures

Figure 1
Figure 1
Study identification, inclusion, and exclusion for meta-analysis. Flow-chart of study selection.
Figure 2
Figure 2
Proportion of Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool criteria fulfilled for included studies. Proportion of all 14 Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool criteria that were fulfilled for eleven studies included in the meta-analysis.
Figure 3
Figure 3
Forrest plot of the sensitivity and specificity of sTREM-1 for the diagnosis of sepsis. Forrest plot of the sensitivity and specificity of each individual study, pooled sensitivity and specificity, and I2 statistic for heterogeneity.
Figure 4
Figure 4
Summary receiver operating characteristic graph of included studies. Summary receiver operating characteristic graph with 95% confidence region and 95% prediction region for sTREM-1.
Figure 5
Figure 5
Fagan's nomogram for calculation of post-test probabilities. Fagan's nomogram for sTREM-1 illustrating post-test probability with a fixed pre-test probability of 62% for sepsis.
Figure 6
Figure 6
Univariable meta-regression and subgroup analysis.
Figure 7
Figure 7
Deeks' funnel plot asymmetry test for publication bias.
See this image and copyright information in PMC

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