Role of sTREM-1 in predicting mortality of infection: a systematic review and meta-analysis
Authors : Longxiang Su, Dan Liu, Wenzhao Chai, Dawei Liu, Yun Long
Abstract
Objectives:
The aim of this meta-analysis was to assess the prognostic value of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) levels in predicting mortality during the initial stage of infection, considering the conflicting results from previous studies.
Methods:
A comprehensive search was conducted in the PubMed, EMBASE, Web of Knowledge, and Cochrane databases. Eligibility of studies and data extraction were independently performed by two authors. A 2x2 contingency table was constructed based on mortality and sTREM-1 levels in infected patients. The prognostic value of sTREM-1 was evaluated using a bivariate meta-analysis model, and heterogeneity was assessed using the Q-test and I2 index.
Results:
From a total of 803 studies, 9 studies were included in the analysis. The meta-analysis revealed that elevated sTREM-1 levels were associated with an increased risk of mortality in infected patients, with a pooled risk ratio (RR) of 2.54 (95% CI 1.77 to 3.65) using a random-effects model (I2=53.8%). The bivariate random-effects regression model yielded a pooled sensitivity of 0.75 (95% CI 0.61 to 0.86) and specificity of 0.66 (95% CI 0.54 to 0.75) for sTREM-1 in predicting mortality. The diagnostic odds ratio (OR) was 6 (95% CI 3 to 10), and the summary receiver operator characteristic (SROC) curve had an area under the curve of 0.76 (95% CI 0.72 to 0.79). Subgroup analysis for sepsis showed a pooled RR of 2.98 (95% CI 2.19 to 4.40), a sensitivity of 0.74 (95% CI 0.58 to 0.85), specificity of 0.72 (95% CI 0.62 to 0.80), and an area under the SROC curve of 0.78 (95% CI 0.74 to 0.81).
Conclusions Elevated sTREM-1 concentrations had a moderate prognostic significance in assessing the mortality of infection in adult patients. However, sTREM-1 alone is insufficient to predict mortality as a biomarker.
Citation: Longxiang Su, Dan Liu, Wenzhao Chai, Dawei Liu, Yun Long Role of sTREM-1 in predicting mortality of infection: a systematic review and meta-analysis BMJ Open 2016;6:e010314 doi:10.1136/bmjopen-2015-010314
Received: 22 October 2015 Revised: 12 April 2016 Accepted: 14 April 2016 Published: 13 May 2016
Copyright: This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Contributors LS, YL and DL conceived and designed the study. LS, DL and WC collected the data, performed the data extraction, conducted the quality assessment and analysed the data. LS and YL wrote the manuscript and also read and approved the final manuscript.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
