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Meta-Analysis
. 2013 May 29;8(5):e65436.
doi: 10.1371/journal.pone.0065436. Print 2013.

Diagnostic value of sTREM-1 in bronchoalveolar lavage fluid in ICU patients with bacterial lung infections: a bivariate meta-analysis

Jia-Xin Shi  1 , Jia-Shu Li, Rong Hu, Chun-Hua Li, Yan Wen, Hong Zheng, Feng Zhang, Qin Li
Affiliations
Meta-Analysis

Diagnostic value of sTREM-1 in bronchoalveolar lavage fluid in ICU patients with bacterial lung infections: a bivariate meta-analysis

Jia-Xin Shi et al. PLoS One. .

Abstract

Background: The serum soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) is a useful biomarker in differentiating bacterial infections from others. However, the diagnostic value of sTREM-1 in bronchoalveolar lavage fluid (BALF) in lung infections has not been well established. We performed a meta-analysis to assess the accuracy of sTREM-1 in BALF for diagnosis of bacterial lung infections in intensive care unit (ICU) patients.

Methods: We searched PUBMED, EMBASE and Web of Knowledge (from January 1966 to October 2012) databases for relevant studies that reported diagnostic accuracy data of BALF sTREM-1 in the diagnosis of bacterial lung infections in ICU patients. Pooled sensitivity, specificity, and positive and negative likelihood ratios were calculated by a bivariate regression analysis. Measures of accuracy and Q point value (Q*) were calculated using summary receiver operating characteristic (SROC) curve. The potential between-studies heterogeneity was explored by subgroup analysis.

Results: Nine studies were included in the present meta-analysis. Overall, the prevalence was 50.6%; the sensitivity was 0.87 (95% confidence interval (CI), 0.72-0.95); the specificity was 0.79 (95% CI, 0.56-0.92); the positive likelihood ratio (PLR) was 4.18 (95% CI, 1.78-9.86); the negative likelihood ratio (NLR) was 0.16 (95% CI, 0.07-0.36), and the diagnostic odds ratio (DOR) was 25.60 (95% CI, 7.28-89.93). The area under the SROC curve was 0.91 (95% CI, 0.88-0.93), with a Q* of 0.83. Subgroup analysis showed that the assay method and cutoff value influenced the diagnostic accuracy of sTREM-1.

Conclusions: BALF sTREM-1 is a useful biomarker of bacterial lung infections in ICU patients. Further studies are needed to confirm the optimized cutoff value.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow diagram of identification of relevant studies.
Figure 2
Figure 2. Methodological quality assessment of the included studies.
Data are presented as a percentages bar across all included studies.
Figure 3
Figure 3. Forest plot of the sensitivity (A) and specificity (B) of BALF sTREM-1 in the diagnosis of bacterial lung infections in ICU patients.
The results were as follows: sensitivity, 0.87 (95% CI, 0.72–0.95); specificity, 0.79 (95% CI, 0.56–0.92).
Figure 4
Figure 4. Scattergram of the positive likelihood ratio (PLR) and negative likelihood ratio (NLR).
The results were as follows: PLR 4.18 (95% CI, 1.78–9.86), NLR 0.16 (95% CI, 0.07–0.36).
Figure 5
Figure 5. Summary receiver operating characteristic (SROC) curve for BALF sTREM-1 tests (9 studies).
AUC = 0.91 (95% CI, 0.88–0.93), Q* = 0.83.
Figure 6
Figure 6. Fagan's nomogram for likelihood ratios and the probability for BALF sTREM-1 assays in the diagnosis of bacterial lung infections.
The pre-test probability of disease was 51%.
Figure 7
Figure 7. Forest plot of subgroup analysis for sensitivity and specificity.
* P<0.05; ** P<0.01; *** P<0.001.
Figure 8
Figure 8. The Deek's funnel plot for the assessment of potential publication bias.
There was no significant publication bias (P = 0.06).
See this image and copyright information in PMC

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