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Pleural fluid soluble triggering receptor expressed on myeloid cells-1 as a marker of bacterial infection: a
Hanssa Summah1, Li-Li Tao, Ying-Gang Zhu
1Department of Pulmonary Medicine, Huadong Hospital, Shanghai Medical College, Fudan University, People's Republic of China.
Background:
Pleural infection is a common clinical problem. Its successful treatment depends on rapid diagnosis and early initiation of antibiotics. The measurement of soluble triggering receptor expressed in myeloid cells-1 (sTREM-1) level in pleural effusions has proven to be a valuable diagnostic tool for differentiating bacterial effusions from effusions of other etiologies. Herein, we performed a meta-analysis to assess the accuracy of pleural fluid sTREM-1 in the diagnosis of bacterial infection.
Methods:
We searched Web of Knowledge and Medline from 1990 through March 2011 for studies reporting diagnostic accuracy data regarding the use of sTREM-1 in the diagnosis of bacterial pleural effusions. Pooled sensitivity and specificity and summary measures of accuracy and Q* were calculated.
Results:
Overall, the sensitivity of sTREM-1was 78% (95% CI: 72%-83%); the specificity was 84% (95% CI: 80%-87%); the positive likelihood ratio was 6.0 (95% CI: 3.3-10.7); and the negative likelihood ratio was 0.22 (95% CI: 0.12-0.40). The area under the SROC curve for sTREM-1 was 0.92. Statistical heterogeneity and inconsistency were found for sensitivity (p = 0.015, χ2 = 15.73, I2 = 61.9%), specificity (p = 0.000, χ2 = 29.90, I2 = 79.9%), positive likelihood ratio (p = 0.000, χ2 = 33.09, I2 = 81.9%), negative likelihood ratio (p = 0.008, χ2 = 17.25, I2 = 65.2%), and diagnostic odds ratio (p = 0.000, χ2 = 28.49, I2 = 78.9%). A meta-regression analysis performed showed that the Quality Assessment of Diagnostic Accuracy Studies score (p = 0.3245; RDOR, 4.34; 95% CI, 0.11 to 164.01), the Standards for Reporting of Diagnostic Accuracy score (p = 0.3331; RDOR, 1.70; 95% CI, 0.44 to 6.52), lack of blinding (p = 0.7439; RDOR, 0.60; 95% CI, 0.01 to 33.80), and whether the studies were prospective or retrospective studies (p = 0.2068; RDOR, 7.44; 95% CI, 0.18 to 301.17) did not affect the test accuracy. A funnel plot for publication bias suggested a remarkable trend of publication bias.
Conclusions:
Our findings suggest that sTREM-1 has a good diagnostic accuracy and may provide a useful adjunctive tool for the diagnosis of bacterial pleural effusions. However, further studies are needed in order to identify any differences in the diagnostic performance of sTREM-1 of parapneumonic effusions and empyemas.
Insights
Soluble triggering receptor expressed in myeloid cells-1 (sTREM-1) shows good accuracy in diagnosing bacterial pleural effusions. This biomarker can serve as a valuable tool to aid in the early detection of pleural infections.
Area of Science:
- Medical Diagnostics
- Biomarker Research
- Infectious Diseases
Background:
- Pleural infection is a common condition requiring prompt diagnosis and antibiotic treatment.
- Accurate differentiation of bacterial pleural effusions from other causes is crucial for effective management.
- Soluble triggering receptor expressed in myeloid cells-1 (sTREM-1) is a potential biomarker for bacterial pleural infections.
Purpose of the Study:
- To conduct a meta-analysis evaluating the diagnostic accuracy of pleural fluid sTREM-1 for bacterial infections.
- To determine the pooled sensitivity, specificity, and likelihood ratios of sTREM-1 in diagnosing bacterial pleural effusions.
Main Methods:
- A systematic literature search was performed on Web of Knowledge and Medline (1990-March 2011).
- Studies reporting diagnostic accuracy data for sTREM-1 in bacterial pleural effusions were included.
- Pooled sensitivity, specificity, and summary accuracy measures were calculated using meta-analysis techniques.
Main Results:
- The pooled sensitivity of sTREM-1 was 78% (95% CI: 72%-83%) and specificity was 84% (95% CI: 80%-87%).
- The area under the SROC curve was 0.92, indicating good diagnostic performance.
- Significant heterogeneity was observed for most accuracy measures, and publication bias was suggested.
Conclusions:
- sTREM-1 demonstrates good diagnostic accuracy and can be a useful adjunctive tool for diagnosing bacterial pleural effusions.
- Further research is warranted to differentiate the diagnostic performance of sTREM-1 in parapneumonic effusions versus empyemas.
