Fiona Howroyd, Amanda Veiga Sardeli, Fang Gao Smith, Tonny Veenith, Niharika A Duggal, Zubair Ahmed
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引用次数: 0
Abstract
Background: Major trauma is a significant global health issue. Pneumonia poses an additional risk for morbidity and mortality after major trauma yet identifying pneumonia remains challenging in clinical practice. This systematic review aims to evaluate blood-based biomarkers for pneumonia in major trauma patients.
Methods: The search was performed across four databases up to November 18th 2024, including primary studies investigating blood-based biomarkers associated with pneumonia in adults hospitalised after major trauma (PROSPERO CRD42024542059). Risk of bias was assessed using the ROBINS-E tool and meta-analysis was performed of pooled data.
Results: Among 20 included studies, with a total of 4316 participants, the pooled mean pneumonia rate was 32.7% (23.5%-43.4%). Seventy biomarkers for post-operative pneumonia were identified, with meta-analysis possible for 12 of the reported biomarkers. At admission interleukin (IL)-6 (standardised mean difference: 1.41 (0.04-2.77), p = 0.04), cytokeratin fragment 21-1 (CYFRA21-1; 0.53 (0.19-0.86), p = 0.002) and leucocyte count (0.28 (0.05-0.50), p = 0.01) were higher in patients who developed pneumonia. During hospitalisation, patients with pneumonia had significantly higher IL-10 (4.42 (3.89-4.95), p > 0.001) and neutrophil oxidative burst capacity (1.52 (0.96-2.09), p > 0.001) at day 1, CYFRA21-1 at day 2 (0.43 (0.10-0.76), p = 0.01), IL-6 at day 3 (3.11 (2.66-3.55), p > 0.001) and day 5 (0.57 (0.05-1.09), p = 0.03) and CRP at day 4 (1.87 (1.51-2.24), p > 0.001), day 5 (1.38 (1.03-1.72), p > 0.001), day 6 (0.74 (0.42-1.06), p > 0.001) and day 7 (0.87 (0.12-1.63), p = 0.02). Across the included studies, 85% exhibited some concerns to very high risk of bias.
Conclusions: While we identified potential candidate biomarkers for pneumonia in major trauma patients, the high heterogeneity across trauma populations, clinical diagnostic tools and biomarker testing methods warrants further high-quality studies to confirm their clinical value.
期刊介绍:
The Journal of the Intensive Care Society (JICS) is an international, peer-reviewed journal that strives to disseminate clinically and scientifically relevant peer-reviewed research, evaluation, experience and opinion to all staff working in the field of intensive care medicine. Our aim is to inform clinicians on the provision of best practice and provide direction for innovative scientific research in what is one of the broadest and most multi-disciplinary healthcare specialties. While original articles and systematic reviews lie at the heart of the Journal, we also value and recognise the need for opinion articles, case reports and correspondence to guide clinically and scientifically important areas in which conclusive evidence is lacking. The style of the Journal is based on its founding mission statement to ‘instruct, inform and entertain by encompassing the best aspects of both tabloid and broadsheet''.