Role of sTREM-1 in predicting mortality of infection: a systematic review and meta-analysis

• Published in: BMJ open Vol. 6; no. 5; p. e010314
• Main Authors: Su, Longxiang, Liu, Dan, Chai, Wenzhao, Liu, Dawei, Long, Yun
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 13.05.2016; BMJ Publishing Group
• Subjects: Biomarkers - analysis; Humans; Intensive Care; Myeloid Cells - metabolism; Predictive Value of Tests; Prognosis; ROC Curve; Sensitivity and Specificity; Sepsis - blood; Sepsis - mortality; Systematic review; Triggering Receptor Expressed on Myeloid Cells-1 - analysis; meta-analysis; mortality; infection; sTREM-1
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2015-010314

ObjectivesSeveral studies have investigated the prognostic value of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in patients with infection. However, the result was controversial. Thus, the purpose of the present meta-analysis was to determine the prognostic value of the sTREM-1 level in predicting mortality at the initial stage of infection.MethodsThe literature was searched in the PubMed, EMBASE, Web of Knowledge and Cochrane databases. A 2×2 contingency table was constructed on the basis of mortality and sTREM-1 levels in patients with infection. 2 authors independently judged study eligibility and extracted data. The prognostic value of sTREM-1 in predicting mortality was determined using a bivariate meta-analysis model. Q-test and I2 index were used to test heterogeneity.Results9 studies were selected from 803 studies. An elevated sTREM-1 level was associated with a higher risk of death in infection, with pooled risk ratio (RR) was 2.54 (95% CI 1.77 to 3.65) using a random-effects model (I2=53.8%). With the bivariate random-effects regression model, the pooled sensitivity and specificity of sTREM-1 to predict mortality in infection were 0.75 (95% CI 0.61 to 0.86) and 0.66 (95% CI 0.54 to 0.75), respectively. The diagnostic OR was 6 (95% CI 3 to 10). The overall area under the summary receiver operator characteristic (SROC) curve was 0.76 (95% CI 0.72 to 0.79). When we calculated the sepsis subgroup, the pooled RR was 2.98 (95% CI 2.19 to 4.40). The pooled sensitivity and specificity were 0.74 (95% CI 0.58 to 0.85) and 0.72 (95% CI 0.62 to 0.80), respectively. The overall area under the SROC curve was 0.78 (95% CI 0.74 to 0.81).ConclusionsElevated 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.