炎症生物标志物预测结直肠术后吻合口瘘的有效性:系统回顾和荟萃分析

Q4 Medicine
N. Rama, Marlene Lages, Candida G. Silva, Patrícia C Motta Lima, Ines Campos Gil, M. Guarino, P. Oliveira, M. Dixe, A. Rocha, F. Castro-Poças, J. Pimentel
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引用次数: 0

摘要

目的:吻合口漏(AL)是结直肠手术术后严重的并发症,临床前诊断可改善预后,增加吻合口抢救。本研究旨在评估血清生物标志物在结肠直肠AL早期检测中的附加价值。方法:我们进行了全面的文献综述,并对MEDLINE、Embase、PubMed、Web of Science、Scopus和Cochrane图书馆的论文进行了定性和定量分析。我们纳入了2021年9月之前发表的所有评估血清生物标志物白细胞(WBC)、c反应蛋白(CRP)、降钙素原(PCT)和钙保护蛋白(CLP)对AL早期诊断的研究。结果:15项研究评估了AL背景下三种不同的系统生物标志物,包括5150例患者。在术后第5天(POD), CRP的AUC(87.1%)和特异性(80.2%)估计最高。根据POD对生物标志物CRP、PCT和WBC进行随机效应荟萃分析和总效应大小估计。出现AL的患者血清生物标志物的浓度明显较高。在定性分析方面,每篇论文的定义中包含的结直肠AL共识定义的不同亚类存在显著的异质性。结论:血清生物标志物CRP和PCT是AL的中度预测因子,在研究中显示出较高的异质性。这些生物标记物的组合可能会提高预测的准确性,但需要更多的研究来进行质量回归。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Usefulness of Inflammatory Biomarkers to Predict Anastomotic Leakage after Colorectal Surgery: Systematic Review and Meta-Analysis
Aim: Anastomotic leakage (AL) is a severe postoperative complication in colorectal surgery, but its preclinical diagnosis may improve outcomes and increase anastomotic salvage. This study aimed to assess the added value of serum biomarkers for early detection of colorectal AL. Method: We performed a comprehensive literature review, and a qualitative and quantitative analysis of papers retrieved from MEDLINE, Embase, PubMed, Web of Science, Scopus and the Cochrane Library. We included all studies published before September 2021 assessing the serum biomarkers white blood cells (WBC), C-reactive protein (CRP), procalcitonin (PCT) and calprotectin (CLP) for the early diagnosis of AL. Results: Fifteen studies that evaluated three different systemic biomarkers in the context of AL were identified, including 5150 patients. Diagnostic test accuracy was estimated for CRP and PCT. On postoperative day (POD) 5, the highest AUC (87.1%) and specificity (80.2%) values were estimated for CRP. Random-effects meta-analysis and total effect sizes estimation for the biomarkers CRP, PCT and WBC were performed according to POD. The concentration of serum biomarkers is significantly higher in patients presenting AL. Regarding the qualitative analysis, there was significant heterogeneity in the inclusion of different subcategories of the consensus definition of colorectal AL in each paper’s definition. Conclusion: The serum biomarkers CRP and PCT are moderate predictors for AL, showing a high heterogeneity among the studies. Combinations of these biomarkers might improve predictive accuracy, but more studies will be necessary to conduct a quality metaregression.
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来源期刊
Surgery, Gastroenterology and Oncology
Surgery, Gastroenterology and Oncology Medicine-Gastroenterology
CiteScore
0.30
自引率
0.00%
发文量
11
期刊介绍: Starting with this issue "Annals of Fundeni Hospital", founded in 1996 as the scientific journal of the prestigious hospital Fundeni becomes "Journal of Translational Medicine and Research" (JTMR), an Journal of the Academy of Medical Sciences of Romania. Therefore, an 18 years old Journal, attested and indexed in Elsevier Bibliographic Databases, Amsterdam and also indexed in SCOPUS, is continuing a tradition of excellence that lasted almost two decades. The new title of the Journal is inspired first of all from the important developments of translational research In Fundeni Clinical Institute and the "C.C Iliescu Institute for Cardio-Vascular Diseases", in parallel with the national and international trend to promote and develop this important area or medical research. Although devoted mainly to translational research, JTMR will continue to promote both basic and clinical research.
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