重大创伤后肺炎的生物标志物:系统回顾和荟萃分析。

IF 1.4 Q3 CRITICAL CARE MEDICINE
Fiona Howroyd, Amanda Veiga Sardeli, Fang Gao Smith, Tonny Veenith, Niharika A Duggal, Zubair Ahmed
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引用次数: 0

摘要

背景:重大创伤是一个重大的全球健康问题。肺炎对重大创伤后的发病率和死亡率有额外的风险,但在临床实践中识别肺炎仍然具有挑战性。本系统综述旨在评估基于血液的生物标志物在重大创伤患者肺炎。方法:检索在四个数据库中进行,截至2024年11月18日,包括调查重大创伤后住院成人肺炎相关血液生物标志物的初步研究(PROSPERO CRD42024542059)。使用ROBINS-E工具评估偏倚风险,并对汇总数据进行荟萃分析。结果:纳入的20项研究共纳入4316名受试者,合并平均肺炎发生率为32.7%(23.5%-43.4%)。确定了70个术后肺炎的生物标志物,并对其中12个报道的生物标志物进行了荟萃分析。入院时,白细胞介素(IL)-6(标准化平均差:1.41 (0.04-2.77),p = 0.04),细胞角蛋白片段21-1 (CYFRA21-1;肺炎患者白细胞计数(0.53 (0.19-0.86),p = 0.002)和白细胞计数(0.28 (0.05-0.50),p = 0.01)较高。在住院治疗期间,患者肺炎有显著较高的il - 10 (4.42 (3.89 - -4.95), p > 0.001)和中性粒细胞氧化破裂能力(1.52 (0.96 - -2.09),p > 0.001)在第一天,CYFRA21-1在第二天(0.43 (0.10 - -0.76),p = 0.01), il - 6在第三天(3.11 (2.66 - -3.55),p > 0.001),第五天(0.57 (0.05 - -1.09),p = 0.03)和c反应蛋白在第四天(1.87 (1.51 - -2.24),p > 0.001),第五天(1.38 (1.03 - -1.72),p > 0.001),一天6 (0.74 (0.42 - -1.06),p > 0.001),第七天(0.87 (0.12 - -1.63),p = 0.02)。在纳入的研究中,85%的研究表现出对非常高的偏倚风险的担忧。结论:虽然我们确定了重大创伤患者肺炎的潜在候选生物标志物,但创伤人群、临床诊断工具和生物标志物检测方法的高度异质性需要进一步的高质量研究来证实其临床价值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Biomarkers for pneumonia after major trauma: A systematic review and meta-analysis.

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.

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来源期刊
Journal of the Intensive Care Society
Journal of the Intensive Care Society Nursing-Critical Care Nursing
CiteScore
4.40
自引率
0.00%
发文量
45
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''.
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