The Comparison of Diagnostic Value of Procalcitonin and Soluble Triggering Receptor Expressed on Myeloid Cells-1 for Ventilator-associated Pneumonia: A Meta-analysis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

FengXia ¹ , JiangLibing ² , MaYuefeng ² , ZhangMao ² , ZhaoZeyuan ¹ ,  ZhangJianyong ¹

1. The Second Department of Respiratory Medicine, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, 563000, China;
2. ;

Corresponding?author：

ZhangJianyong, Email: zjyzyyxy@163.com

Keywords：

Ventilator-associated pneumonia; Soluble triggering receptor expressed on myeloid cells-1; Procalcitonin; Meta-analysis

DOI：

10.7507/1671-6205.2015010

Video：

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Objective To compare and evaluate the diagnostic value of procalcitonin(PCT) and soluble triggering receptor expressed on myeloid cells-1(sTREM-1) for ventilator-associated pneumonia(VAP). Methods The related studies were systematically searched in PubMed, OvidSP (EMBASE), Cochrane Library, clinicaltrials.gov, EBSCO, CBM, CNKI and Wanfang database and the methodological quality of all eligible studies were assessed using the Quality Assessment for Studies of Diagnostic Accuracy (QUADAS) tool. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio (DOR), and areas under the summary receiver operating characteristic (sROC) curve of PCT and sTREM-1 were pooled by Meta-disc software, respectively. Area under the sROC curve (AUC) was compared using Z-test. In addition, Bayes's theorem was used to calculate the probability of VAP, conditioned by the likelihood ratio as a function of the pretest probability. Results In total, 31 studies were included (20 studies on PCT and 11 studies on sTREM-1). The combined sensitivity, specificity, DOR and AUC of diagnosing VAP by PCT was 0.78, 0.74, 15.21, and 0.868, respectively. And the combined sensitivity, specificity, DOR and AUC of diagnosing VAP by sTREM-1 was 0.88, 0.80, 30.28, and 0.919, respectively. There was no statistical difference between two areas under the sROC curve (P=0.25). Conclusion sTREM-1 is superior to PCT in diagnosing VAP, however, neither can confirm nor exclude VAP alone.

Citation： FengXia, JiangLibing, MaYuefeng, ZhangMao, ZhaoZeyuan, ZhangJianyong. The Comparison of Diagnostic Value of Procalcitonin and Soluble Triggering Receptor Expressed on Myeloid Cells-1 for Ventilator-associated Pneumonia: A Meta-analysis. Chinese Journal of Respiratory and Critical Care Medicine, 2015, 14(1): 36-41. doi: 10.7507/1671-6205.2015010 Copy

1.	Davis KA.Ventilator-associated pneumonia:a review.J Intensive Care Med, 2006, 21:211-226.
2.	Chastre J, Fagon JY.Ventilator-associated pneumonia.Am J Respir Crit Care, 2002, 165:867-903.
3.	Joseph NM, Sistla S, Dutta TK, et al.Ventilator-associated pneumonia:a review.Eur J Intern Med, 2010, 21:360-368.
4.	Kohlenberg A, Schwab F, Behnke M, et al.Pneumonia associated with invasive and noninvasive ventilation:an analysis of the German nosocomial infection surveillance system database.Intensive Care Med, 2010, 36:971-978.
5.	Shorr AF, Chan CM, Zilberberg MD.Diagnostics and epidemiology in ventilator-associated pneumonia.Ther Adv Respir Dis, 2011, 5:121-130.
6.	Melsen WG, Rovers MM, Bonten MJ.Ventilator-associated pneumonia and mortality:a systematic review of observational studies.Crit Care Med, 2009, 37:2709-2718.
7.	Xie DS, Xiong W, Lai RP, et al.Ventilator-associated pneumonia in intensive care units in Hubei Province, China:a multicentre prospective cohort survey.J Hosp Infect, 2011, 78:284-288.
8.	Restrepo MI, Anzueto A, Arroliga AC, et al.Economic burden of ventilator-associated pneumonia based on total resource utilization.Infect Cont Hosp Ep, 2010, 31:509-515.
9.	Jaimes F, De La Rosa G, Gomez E, et al.Incidence and risk factors for ventilator-associated pneumonia in a developing country:where is the difference? Respir Med, 2007, 101:762-767.
10.	Postolopoulou E, Bakakos P, Katostaras T, et al.Incidence and risk factors for ventilator-associated pneumonia in 4 multidisciplinary intensive care units in Athens, Greece.Respir Care, 2003, 48:681-688.
11.	Ello J, Ollendorf DA, Oster G, et al.Epidemiology and outcomes of ventilator-associated pneumonia in a large US database.Chest, 2002, 122:2115-2121.
12.	Lp E, Voss A.Ventilator associated pneumonia and infection control.Ann Clin Microb Anti, 2006, 5:7.
13.	Morehead RS, Pinto SJ.Ventilator-associated pneumonia.Arch Intern Med, 2000, 160:1926-1936.
14.	Shan J, Chen HL, Zhu JH.Diagnostic accuracy of clinical pulmonary infection score for ventilator-associated pneumonia:a meta-analysis.Respir Care, 2011, 56:1087-1094.
15.	Uzzan B, Cohen R, Nicolas P, et al.Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma:a systematic review and meta-analysis.Crit Care Med, 2006, 34:1996-2003.
16.	Luyt CE, Combes A, Reynaud C, et al.Usefulness of procalcitonin for the diagnosis of ventilator-associated pneumonia.Intensive Care Med, 2008, 34:1434-1440.
17.	Duflo F, Debon R, Monneret G, et al.Alveolar and serum procalcitonin:diagnostic and prognostic value in ventilator-associated pneumonia.Anesthesiology, 2002, 96:74-79.
18.	Ramirez P, Garcia MA, Ferrer M, et al.Sequential measurements of procalcitonin levels in diagnosing ventilator-associated pneumonia.Eur Respir J, 2008, 31:356-362.
19.	Oppert M, Reinicke A, Muller C, et al.Elevations in procalcitonin but not C-reactive protein are associated with pneumonia after cardiopulmonary resuscitation.Resuscitation, 2002, 53:167-170.
20.	Jung B, Embriaco N, Roux F, et al.Microbiogical data, but not procalcitonin improve the accuracy of the clinical pulmonary infection score.Intensive Care Med, 2010, 36:790-798.
21.	廖雪蓮, 金曉東, 康焰, 等.降鈣素原在呼吸機相關性肺炎中的診斷作用.中國危重病急救醫學, 2010, 22:142-145.
22.	張智健, 王立萬, 劉長庭, 等.58例長期機械通氣老年患者血清降鈣素原變化對呼吸機相關性肺炎的診斷意義.第三軍醫大學學報, 2007, 29:990-991.
23.	朱小生, 方長太, 白兆青, 等.降鈣素原對呼吸機相關性肺炎的診斷意義.安徽醫學, 2010, 31:1435-1436.
24.	但勇, 胡仁德, 曾憲華, 等.降鈣素原和臨床肺部感染評分在呼吸機相關性肺炎早期診斷中的相關性研究.中國當代醫藥, 2012, 19:47-48.
25.	周國花, 蔡文訓, 羅華, 等.降鈣素原檢測對呼吸機相關肺炎診治的意義.中國基層醫藥, 2010, 17:3317-3319.
26.	胡冬梅.降鈣素原在小兒呼吸機相關性肺炎中的臨床應用.中外醫學研究, 2013, 26:25.
27.	任芳萍, 劉玲莉.降鈣素原檢測在呼吸機相關性肺炎中的預測價值.吉林醫學, 2013, 34:2239-2240.
28.	高偉良, 陶維華, 傅應云, 等.降鈣素原在呼吸機相關性肺炎早期診斷及病情判斷中的價值.臨床醫學, 2013, 33:20-22.
29.	鄭慧, 劉克喜, 王言理, 等.血清降鈣素原測定對機械通氣患者發生呼吸機相關性肺炎的診斷價值.醫學理論與實踐, 2013, 26:3225-3227.
30.	周承惇, 陸澤元, 任南征, 等.降鈣素原在呼吸機相關性肺炎中的診斷價值.中國危重病急救醫學, 2006, 18:370-372.
31.	尹輝明, 楊宏亮, 劉繼民, 等.監測降鈣素原與感染細胞在呼吸機相關性肺炎的早期診斷價值.中國呼吸與危重監護雜志, 2013, 12:454-456.
32.	何力敏, 張韶岡, 陳于葷, 等.降鈣素原在老年人呼吸機相關性肺炎中的應用.現代預防醫學, 2011, 38:4038-4039.
33.	張芳.降鈣素原、白細胞計數、C反應蛋白在小兒呼吸機相關性肺炎中的表達及臨床意義.實用醫技雜志, 2012, 19:850-851.
34.	蔡曉平, 錢俊峰, 曹卓, 等.動態監測血清降鈣素原在呼吸機相關性肺炎診治中的指導意義.放射免疫學雜志, 2013, 26:247-249.
35.	陳月馨, 張貴昌, 黃晨達, 等.可溶性髓樣細胞觸發受體-1水平在呼吸機相關性肺炎監測中的意義.海南醫學, 2013, 24:2976-2978.
36.	王繼鵬, 王立新.sTREM-1在診斷呼吸機相關性肺炎中的臨床價值.實用醫學雜志, 2012, 28:639-642.
37.	徐園園, 許啟霞, 劉超, 等.可溶性髓系細胞觸發受體-1與呼吸機相關性肺炎.中國全科醫學, 2010, 30:251-254.
38.	張婷婷, 高寶安, 陳世雄, 等.可溶性髓樣細胞觸發受體1對呼吸機相關性肺炎臨床診斷價值的研究.中國呼吸與危重監護雜志, 2012, 11:37-40.
39.	楊向紅, 孫仁華, 陳敏華, 等.呼吸機相關性肺炎患者支氣管肺泡灌洗液sTREM-1的變化及意義.浙江醫學, 2013, 35:341-343.
40.	招云春, 蔡少華, 余德文.可溶性髓樣細胞觸發性受體-1在呼吸機相關性肺炎診斷中的臨床意義.中華醫院感染學雜志, 2011, 21:3784-3787.
41.	Horonenko G, Hoyt JC, Robbins RA, et al.Soluble triggering receptor expressed on myeloid cell-1 is increased in patients with ventilator-associated pneumonia:a preliminary report.Chest, 2007, 132:58-63.
42.	Palazzo SJ, Simpson TA, Simmons JM, et al.Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) as a diagnostic marker of ventilator-associated pneumonia.Respir Care, 2012, 57:2052-2058.
43.	Anand NJ, Zuick S, Klesney-Tait J, et al.Diagnostic implications of soluble triggering receptor expressed on myeloid cells-1 in BAL fluid of patients with pulmonary infiltrates in the ICU.Chest, 2009, 135:641-647.
44.	Gibot S, Cravoisy A, Levy B, et al.Soluble triggering receptor expressed on myeloid cells and the diagnosis of pneumonia.N Engl J Med, 2004, 350:451-458.
45.	Gibot S, Cravoisy A, Dupays R, et al.Combined measurement of procalcitonin and soluble TREM-1 in the diagnosis of nosocomial sepsis.Scand J Infect Dis, 2007, 39:604-608.
46.	Determann RM, Millo JL, Gibot S, et al.Serial changes in soluble triggering receptor expressed on myeloid cells in the lung during development of ventilator-associated pneumonia.Intensive Care Med, 2005, 31:1495-1500.
47.	李華茵, 何禮賢, 胡必杰, 等.重癥監護病房呼吸機相關肺炎臨床與病原學分析.中國呼吸與危重監護雜志, 2005, 4:266-270.
48.	于洪濤, 賈金廣, 王敏, 等.呼吸重癥監護病房呼吸機相關性肺炎的危險因素分析.中國呼吸與危重監護雜志, 2011, 10:69-71.
49.	莫為春, 顧彩峰, 劉國平.降鈣素原的研究及臨床應用新進展.中國社區醫師(醫學專業半月刊), 2009, 11:147.
50.	Klesney-Tait J, Colonna M. Uncovering the TREM-1-TLR connection.Am J Physiol-Lung C, 2007, 293:L1374-L1376.
51.	Oudhuis GJ, Beuving J, Bergmans D, et al.Soluble triggering receptor expressed on myeloid cells-1 in bronchoalveolar lavage fluid is not predictive for ventilator-associated pneumonia.Intensive Care Med, 2009, 35:1265-1270.
52.	Jiyong J, Tiancha H, Wei C, et al.Diagnostic value of the soluble triggering receptor expressed on myeloid cells-1 in bacterial infection:a meta-analysis. Intensive Care Med, 2009, 35:587-595.
53.	吳友平, 李金寶, 鄧小明.可溶性髓細胞觸發受體1對呼吸機相關性肺炎診斷價值的系統評價.中國呼吸與危重監護雜志, 2013, 12:258-263.

1. Davis KA.Ventilator-associated pneumonia:a review.J Intensive Care Med, 2006, 21:211-226.
2. Chastre J, Fagon JY.Ventilator-associated pneumonia.Am J Respir Crit Care, 2002, 165:867-903.
3. Joseph NM, Sistla S, Dutta TK, et al.Ventilator-associated pneumonia:a review.Eur J Intern Med, 2010, 21:360-368.
4. Kohlenberg A, Schwab F, Behnke M, et al.Pneumonia associated with invasive and noninvasive ventilation:an analysis of the German nosocomial infection surveillance system database.Intensive Care Med, 2010, 36:971-978.
5. Shorr AF, Chan CM, Zilberberg MD.Diagnostics and epidemiology in ventilator-associated pneumonia.Ther Adv Respir Dis, 2011, 5:121-130.
6. Melsen WG, Rovers MM, Bonten MJ.Ventilator-associated pneumonia and mortality:a systematic review of observational studies.Crit Care Med, 2009, 37:2709-2718.
7. Xie DS, Xiong W, Lai RP, et al.Ventilator-associated pneumonia in intensive care units in Hubei Province, China:a multicentre prospective cohort survey.J Hosp Infect, 2011, 78:284-288.
8. Restrepo MI, Anzueto A, Arroliga AC, et al.Economic burden of ventilator-associated pneumonia based on total resource utilization.Infect Cont Hosp Ep, 2010, 31:509-515.
9. Jaimes F, De La Rosa G, Gomez E, et al.Incidence and risk factors for ventilator-associated pneumonia in a developing country:where is the difference? Respir Med, 2007, 101:762-767.
10. Postolopoulou E, Bakakos P, Katostaras T, et al.Incidence and risk factors for ventilator-associated pneumonia in 4 multidisciplinary intensive care units in Athens, Greece.Respir Care, 2003, 48:681-688.
11. Ello J, Ollendorf DA, Oster G, et al.Epidemiology and outcomes of ventilator-associated pneumonia in a large US database.Chest, 2002, 122:2115-2121.
12. Lp E, Voss A.Ventilator associated pneumonia and infection control.Ann Clin Microb Anti, 2006, 5:7.
13. Morehead RS, Pinto SJ.Ventilator-associated pneumonia.Arch Intern Med, 2000, 160:1926-1936.
14. Shan J, Chen HL, Zhu JH.Diagnostic accuracy of clinical pulmonary infection score for ventilator-associated pneumonia:a meta-analysis.Respir Care, 2011, 56:1087-1094.
15. Uzzan B, Cohen R, Nicolas P, et al.Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma:a systematic review and meta-analysis.Crit Care Med, 2006, 34:1996-2003.
16. Luyt CE, Combes A, Reynaud C, et al.Usefulness of procalcitonin for the diagnosis of ventilator-associated pneumonia.Intensive Care Med, 2008, 34:1434-1440.
17. Duflo F, Debon R, Monneret G, et al.Alveolar and serum procalcitonin:diagnostic and prognostic value in ventilator-associated pneumonia.Anesthesiology, 2002, 96:74-79.
18. Ramirez P, Garcia MA, Ferrer M, et al.Sequential measurements of procalcitonin levels in diagnosing ventilator-associated pneumonia.Eur Respir J, 2008, 31:356-362.
19. Oppert M, Reinicke A, Muller C, et al.Elevations in procalcitonin but not C-reactive protein are associated with pneumonia after cardiopulmonary resuscitation.Resuscitation, 2002, 53:167-170.
20. Jung B, Embriaco N, Roux F, et al.Microbiogical data, but not procalcitonin improve the accuracy of the clinical pulmonary infection score.Intensive Care Med, 2010, 36:790-798.
21. 廖雪蓮, 金曉東, 康焰, 等.降鈣素原在呼吸機相關性肺炎中的診斷作用.中國危重病急救醫學, 2010, 22:142-145.
22. 張智健, 王立萬, 劉長庭, 等.58例長期機械通氣老年患者血清降鈣素原變化對呼吸機相關性肺炎的診斷意義.第三軍醫大學學報, 2007, 29:990-991.
23. 朱小生, 方長太, 白兆青, 等.降鈣素原對呼吸機相關性肺炎的診斷意義.安徽醫學, 2010, 31:1435-1436.
24. 但勇, 胡仁德, 曾憲華, 等.降鈣素原和臨床肺部感染評分在呼吸機相關性肺炎早期診斷中的相關性研究.中國當代醫藥, 2012, 19:47-48.
25. 周國花, 蔡文訓, 羅華, 等.降鈣素原檢測對呼吸機相關肺炎診治的意義.中國基層醫藥, 2010, 17:3317-3319.
26. 胡冬梅.降鈣素原在小兒呼吸機相關性肺炎中的臨床應用.中外醫學研究, 2013, 26:25.
27. 任芳萍, 劉玲莉.降鈣素原檢測在呼吸機相關性肺炎中的預測價值.吉林醫學, 2013, 34:2239-2240.
28. 高偉良, 陶維華, 傅應云, 等.降鈣素原在呼吸機相關性肺炎早期診斷及病情判斷中的價值.臨床醫學, 2013, 33:20-22.
29. 鄭慧, 劉克喜, 王言理, 等.血清降鈣素原測定對機械通氣患者發生呼吸機相關性肺炎的診斷價值.醫學理論與實踐, 2013, 26:3225-3227.
30. 周承惇, 陸澤元, 任南征, 等.降鈣素原在呼吸機相關性肺炎中的診斷價值.中國危重病急救醫學, 2006, 18:370-372.
31. 尹輝明, 楊宏亮, 劉繼民, 等.監測降鈣素原與感染細胞在呼吸機相關性肺炎的早期診斷價值.中國呼吸與危重監護雜志, 2013, 12:454-456.
32. 何力敏, 張韶岡, 陳于葷, 等.降鈣素原在老年人呼吸機相關性肺炎中的應用.現代預防醫學, 2011, 38:4038-4039.
33. 張芳.降鈣素原、白細胞計數、C反應蛋白在小兒呼吸機相關性肺炎中的表達及臨床意義.實用醫技雜志, 2012, 19:850-851.
34. 蔡曉平, 錢俊峰, 曹卓, 等.動態監測血清降鈣素原在呼吸機相關性肺炎診治中的指導意義.放射免疫學雜志, 2013, 26:247-249.
35. 陳月馨, 張貴昌, 黃晨達, 等.可溶性髓樣細胞觸發受體-1水平在呼吸機相關性肺炎監測中的意義.海南醫學, 2013, 24:2976-2978.
36. 王繼鵬, 王立新.sTREM-1在診斷呼吸機相關性肺炎中的臨床價值.實用醫學雜志, 2012, 28:639-642.
37. 徐園園, 許啟霞, 劉超, 等.可溶性髓系細胞觸發受體-1與呼吸機相關性肺炎.中國全科醫學, 2010, 30:251-254.
38. 張婷婷, 高寶安, 陳世雄, 等.可溶性髓樣細胞觸發受體1對呼吸機相關性肺炎臨床診斷價值的研究.中國呼吸與危重監護雜志, 2012, 11:37-40.
39. 楊向紅, 孫仁華, 陳敏華, 等.呼吸機相關性肺炎患者支氣管肺泡灌洗液sTREM-1的變化及意義.浙江醫學, 2013, 35:341-343.
40. 招云春, 蔡少華, 余德文.可溶性髓樣細胞觸發性受體-1在呼吸機相關性肺炎診斷中的臨床意義.中華醫院感染學雜志, 2011, 21:3784-3787.
41. Horonenko G, Hoyt JC, Robbins RA, et al.Soluble triggering receptor expressed on myeloid cell-1 is increased in patients with ventilator-associated pneumonia:a preliminary report.Chest, 2007, 132:58-63.
42. Palazzo SJ, Simpson TA, Simmons JM, et al.Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) as a diagnostic marker of ventilator-associated pneumonia.Respir Care, 2012, 57:2052-2058.
43. Anand NJ, Zuick S, Klesney-Tait J, et al.Diagnostic implications of soluble triggering receptor expressed on myeloid cells-1 in BAL fluid of patients with pulmonary infiltrates in the ICU.Chest, 2009, 135:641-647.
44. Gibot S, Cravoisy A, Levy B, et al.Soluble triggering receptor expressed on myeloid cells and the diagnosis of pneumonia.N Engl J Med, 2004, 350:451-458.
45. Gibot S, Cravoisy A, Dupays R, et al.Combined measurement of procalcitonin and soluble TREM-1 in the diagnosis of nosocomial sepsis.Scand J Infect Dis, 2007, 39:604-608.
46. Determann RM, Millo JL, Gibot S, et al.Serial changes in soluble triggering receptor expressed on myeloid cells in the lung during development of ventilator-associated pneumonia.Intensive Care Med, 2005, 31:1495-1500.
47. 李華茵, 何禮賢, 胡必杰, 等.重癥監護病房呼吸機相關肺炎臨床與病原學分析.中國呼吸與危重監護雜志, 2005, 4:266-270.
48. 于洪濤, 賈金廣, 王敏, 等.呼吸重癥監護病房呼吸機相關性肺炎的危險因素分析.中國呼吸與危重監護雜志, 2011, 10:69-71.
49. 莫為春, 顧彩峰, 劉國平.降鈣素原的研究及臨床應用新進展.中國社區醫師(醫學專業半月刊), 2009, 11:147.
50. Klesney-Tait J, Colonna M. Uncovering the TREM-1-TLR connection.Am J Physiol-Lung C, 2007, 293:L1374-L1376.
51. Oudhuis GJ, Beuving J, Bergmans D, et al.Soluble triggering receptor expressed on myeloid cells-1 in bronchoalveolar lavage fluid is not predictive for ventilator-associated pneumonia.Intensive Care Med, 2009, 35:1265-1270.
52. Jiyong J, Tiancha H, Wei C, et al.Diagnostic value of the soluble triggering receptor expressed on myeloid cells-1 in bacterial infection:a meta-analysis. Intensive Care Med, 2009, 35:587-595.
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Chinese Journal of Respiratory and Critical Care Medicine

The Comparison of Diagnostic Value of Procalcitonin and Soluble Triggering Receptor Expressed on Myeloid Cells-1 for Ventilator-associated Pneumonia: A Meta-analysis

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