Biomarkers for intensive care unit-acquired weakness: a systematic review for prediction, diagnosis and prognosis.

IF 5.5 1区医学 Q1 CRITICAL CARE MEDICINE

Annals of Intensive Care Pub Date : 2025-07-02 DOI:10.1186/s13613-025-01500-9

Jiamei Song, Ting Deng, Qingmei Yu, Xun Luo, Yanmei Miao, Leiyu Xie, Yongming Mei, Peng Xie, Shaolin Chen

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引用次数: 0

Abstract

Background: Intensive care unit-acquired weakness (ICU-AW) is a common and debilitating complication in critically ill patients, significantly affecting both short- and long-term outcomes. The existing ICU-AW diagnostic methods are not widely accepted and have a narrow application window. Biomarkers offer potential for diagnosing, predicting, and prognosticating ICU-AW, but a comprehensive synthesis of the available evidence is still lacking.

Methods: We conducted a systematic search across PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang Database, China Science and Technology Journal Database (VIP Database), and China Biomedical Literature Database (SinoMed Database) from inception to January 23, 2025. Study quality was assessed using the revised Newcastle-Ottawa scale and the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Data extraction included basic characteristics of the included studies, name of biomarkers, objective, specimen types, sampling time, type of biomarker, ICU-AW diagnostic criteria, and outcomes.

Results: Out of 5,769 publications screened, 11 studies of moderate to high quality (scores ≥ 6) involving 1,176 critically ill patients were included. Ten biomarkers were identified and categorized into five mechanisms: muscle injury (myoglobin, N-titin, urinary titin), metabolic pathway (glucose transporter protein type-4), neurological injury (neurofilament light/heavy chain), stress response (growth differentiation factor-15), and inflammatory process (monocyte chemoattractant protein-1, NETs marker cfDNA, and miR-181a). Six biomarkers demonstrated strong predictive and diagnostic accuracy with AUC values exceeding 0.80. Notably, growth differentiation factor-15 exhibited excellent clinical utility across diagnostic, predictive, and prognostic applications (AUC ≥ 0.85). The remaining four biomarkers showed moderate performance, with AUC values ranging from 0.60 to 0.80.

Conclusion: While ten biomarkers exhibit potential for ICU-AW assessment, their clinical utility remains inconsistent. This highlights the need for large-scale, prospective validation studies and the incorporation of advanced technologies to refine existing biomarkers and identify novel candidates for ICU-AW prediction, diagnosis and management.

Date of registration: Registered 1 August 2024.

Trial registration: PROSPERO ID: CRD42024574437.

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重症监护病房获得性弱点的生物标志物：预测、诊断和预后的系统综述。

背景：重症监护病房获得性虚弱（ICU-AW）是危重患者中一种常见且使人衰弱的并发症，对短期和长期预后都有显著影响。现有的ICU-AW诊断方法不被广泛接受，应用范围窄。生物标志物为诊断、预测和预测ICU-AW提供了潜力，但目前仍缺乏对现有证据的全面综合。方法：系统检索PubMed、Cochrane Library、Embase、Web of Science、CNKI、万方数据库、中国科技期刊库（VIP数据库）、中国生物医学文献库（SinoMed数据库）自成立至2025年1月23日的数据库。使用修订的纽卡斯尔-渥太华量表和诊断准确性研究质量评估-2工具评估研究质量。数据提取包括纳入研究的基本特征、生物标志物名称、目的、标本类型、采样时间、生物标志物类型、ICU-AW诊断标准和结果。结果：在筛选的5,769篇出版物中，纳入了11项中等至高质量（评分≥6）的研究，涉及1,176名危重患者。确定了10种生物标志物，并将其归类为5种机制：肌肉损伤（肌红蛋白、N-titin、尿titin）、代谢途径（葡萄糖转运蛋白4型）、神经损伤（神经丝轻/重链）、应激反应（生长分化因子15）和炎症过程（单核细胞趋化蛋白-1、NETs标记物cfDNA和miR-181a）。6个生物标志物显示出很强的预测和诊断准确性，AUC值超过0.80。值得注意的是，生长分化因子-15在诊断、预测和预后方面表现出出色的临床应用（AUC≥0.85）。其余四种生物标志物表现出中等的性能，AUC值在0.60至0.80之间。结论：虽然有10种生物标志物具有评估ICU-AW的潜力，但它们的临床应用仍然不一致。这凸显了对大规模、前瞻性验证研究的需求，并结合先进技术来完善现有的生物标志物，并确定用于ICU-AW预测、诊断和管理的新候选物。注册日期：2024年8月1日注册。试验注册：PROSPERO ID: CRD42024574437。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Intensive Care CRITICAL CARE MEDICINE-

CiteScore

14.20

自引率

3.70%

发文量

107

审稿时长

13 weeks

期刊介绍： Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.