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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Abstract Full text Figures/Tables Video References Cited by

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.	廖雪莲, 金晓东, 康焰, 等.降钙素原在呼吸机相关性肺炎中的诊断作用.中国危重病急救医学, 2010, 22:142-145.
22.	张智健, 王立万, 刘长庭, 等.58例长期机械通气老年患者血清降钙素原变化对呼吸机相关性肺炎的诊断意义.第三军医大学学报, 2007, 29:990-991.
23.	朱小生, 方长太, 白兆青, 等.降钙素原对呼吸机相关性肺炎的诊断意义.安徽医学, 2010, 31:1435-1436.
24.	但勇, 胡仁德, 曾宪华, 等.降钙素原和临床肺部感染评分在呼吸机相关性肺炎早期诊断中的相关性研究.中国当代医药, 2012, 19:47-48.
25.	周国花, 蔡文训, 罗华, 等.降钙素原检测对呼吸机相关肺炎诊治的意义.中国基层医药, 2010, 17:3317-3319.
26.	胡冬梅.降钙素原在小儿呼吸机相关性肺炎中的临床应用.中外医学研究, 2013, 26:25.
27.	任芳萍, 刘玲莉.降钙素原检测在呼吸机相关性肺炎中的预测价值.吉林医学, 2013, 34:2239-2240.
28.	高伟良, 陶维华, 傅应云, 等.降钙素原在呼吸机相关性肺炎早期诊断及病情判断中的价值.临床医学, 2013, 33:20-22.
29.	郑慧, 刘克喜, 王言理, 等.血清降钙素原测定对机械通气患者发生呼吸机相关性肺炎的诊断价值.医学理论与实践, 2013, 26:3225-3227.
30.	周承惇, 陆泽元, 任南征, 等.降钙素原在呼吸机相关性肺炎中的诊断价值.中国危重病急救医学, 2006, 18:370-372.
31.	尹辉明, 杨宏亮, 刘继民, 等.监测降钙素原与感染细胞在呼吸机相关性肺炎的早期诊断价值.中国呼吸与危重监护杂志, 2013, 12:454-456.
32.	何力敏, 张韶冈, 陈于荤, 等.降钙素原在老年人呼吸机相关性肺炎中的应用.现代预防医学, 2011, 38:4038-4039.
33.	张芳.降钙素原、白细胞计数、C反应蛋白在小儿呼吸机相关性肺炎中的表达及临床意义.实用医技杂志, 2012, 19:850-851.
34.	蔡晓平, 钱俊峰, 曹卓, 等.动态监测血清降钙素原在呼吸机相关性肺炎诊治中的指导意义.放射免疫学杂志, 2013, 26:247-249.
35.	陈月馨, 张贵昌, 黄晨达, 等.可溶性髓样细胞触发受体-1水平在呼吸机相关性肺炎监测中的意义.海南医学, 2013, 24:2976-2978.
36.	王继鹏, 王立新.sTREM-1在诊断呼吸机相关性肺炎中的临床价值.实用医学杂志, 2012, 28:639-642.
37.	徐园园, 许启霞, 刘超, 等.可溶性髓系细胞触发受体-1与呼吸机相关性肺炎.中国全科医学, 2010, 30:251-254.
38.	张婷婷, 高宝安, 陈世雄, 等.可溶性髓样细胞触发受体1对呼吸机相关性肺炎临床诊断价值的研究.中国呼吸与危重监护杂志, 2012, 11:37-40.
39.	杨向红, 孙仁华, 陈敏华, 等.呼吸机相关性肺炎患者支气管肺泡灌洗液sTREM-1的变化及意义.浙江医学, 2013, 35:341-343.
40.	招云春, 蔡少华, 余德文.可溶性髓样细胞触发性受体-1在呼吸机相关性肺炎诊断中的临床意义.中华医院感染学杂志, 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.	李华茵, 何礼贤, 胡必杰, 等.重症监护病房呼吸机相关肺炎临床与病原学分析.中国呼吸与危重监护杂志, 2005, 4:266-270.
48.	于洪涛, 贾金广, 王敏, 等.呼吸重症监护病房呼吸机相关性肺炎的危险因素分析.中国呼吸与危重监护杂志, 2011, 10:69-71.
49.	莫为春, 顾彩峰, 刘国平.降钙素原的研究及临床应用新进展.中国社区医师(医学专业半月刊), 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.	吴友平, 李金宝, 邓小明.可溶性髓细胞触发受体1对呼吸机相关性肺炎诊断价值的系统评价.中国呼吸与危重监护杂志, 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. 廖雪莲, 金晓东, 康焰, 等.降钙素原在呼吸机相关性肺炎中的诊断作用.中国危重病急救医学, 2010, 22:142-145.
22. 张智健, 王立万, 刘长庭, 等.58例长期机械通气老年患者血清降钙素原变化对呼吸机相关性肺炎的诊断意义.第三军医大学学报, 2007, 29:990-991.
23. 朱小生, 方长太, 白兆青, 等.降钙素原对呼吸机相关性肺炎的诊断意义.安徽医学, 2010, 31:1435-1436.
24. 但勇, 胡仁德, 曾宪华, 等.降钙素原和临床肺部感染评分在呼吸机相关性肺炎早期诊断中的相关性研究.中国当代医药, 2012, 19:47-48.
25. 周国花, 蔡文训, 罗华, 等.降钙素原检测对呼吸机相关肺炎诊治的意义.中国基层医药, 2010, 17:3317-3319.
26. 胡冬梅.降钙素原在小儿呼吸机相关性肺炎中的临床应用.中外医学研究, 2013, 26:25.
27. 任芳萍, 刘玲莉.降钙素原检测在呼吸机相关性肺炎中的预测价值.吉林医学, 2013, 34:2239-2240.
28. 高伟良, 陶维华, 傅应云, 等.降钙素原在呼吸机相关性肺炎早期诊断及病情判断中的价值.临床医学, 2013, 33:20-22.
29. 郑慧, 刘克喜, 王言理, 等.血清降钙素原测定对机械通气患者发生呼吸机相关性肺炎的诊断价值.医学理论与实践, 2013, 26:3225-3227.
30. 周承惇, 陆泽元, 任南征, 等.降钙素原在呼吸机相关性肺炎中的诊断价值.中国危重病急救医学, 2006, 18:370-372.
31. 尹辉明, 杨宏亮, 刘继民, 等.监测降钙素原与感染细胞在呼吸机相关性肺炎的早期诊断价值.中国呼吸与危重监护杂志, 2013, 12:454-456.
32. 何力敏, 张韶冈, 陈于荤, 等.降钙素原在老年人呼吸机相关性肺炎中的应用.现代预防医学, 2011, 38:4038-4039.
33. 张芳.降钙素原、白细胞计数、C反应蛋白在小儿呼吸机相关性肺炎中的表达及临床意义.实用医技杂志, 2012, 19:850-851.
34. 蔡晓平, 钱俊峰, 曹卓, 等.动态监测血清降钙素原在呼吸机相关性肺炎诊治中的指导意义.放射免疫学杂志, 2013, 26:247-249.
35. 陈月馨, 张贵昌, 黄晨达, 等.可溶性髓样细胞触发受体-1水平在呼吸机相关性肺炎监测中的意义.海南医学, 2013, 24:2976-2978.
36. 王继鹏, 王立新.sTREM-1在诊断呼吸机相关性肺炎中的临床价值.实用医学杂志, 2012, 28:639-642.
37. 徐园园, 许启霞, 刘超, 等.可溶性髓系细胞触发受体-1与呼吸机相关性肺炎.中国全科医学, 2010, 30:251-254.
38. 张婷婷, 高宝安, 陈世雄, 等.可溶性髓样细胞触发受体1对呼吸机相关性肺炎临床诊断价值的研究.中国呼吸与危重监护杂志, 2012, 11:37-40.
39. 杨向红, 孙仁华, 陈敏华, 等.呼吸机相关性肺炎患者支气管肺泡灌洗液sTREM-1的变化及意义.浙江医学, 2013, 35:341-343.
40. 招云春, 蔡少华, 余德文.可溶性髓样细胞触发性受体-1在呼吸机相关性肺炎诊断中的临床意义.中华医院感染学杂志, 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. 李华茵, 何礼贤, 胡必杰, 等.重症监护病房呼吸机相关肺炎临床与病原学分析.中国呼吸与危重监护杂志, 2005, 4:266-270.
48. 于洪涛, 贾金广, 王敏, 等.呼吸重症监护病房呼吸机相关性肺炎的危险因素分析.中国呼吸与危重监护杂志, 2011, 10:69-71.
49. 莫为春, 顾彩峰, 刘国平.降钙素原的研究及临床应用新进展.中国社区医师(医学专业半月刊), 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. 吴友平, 李金宝, 邓小明.可溶性髓细胞触发受体1对呼吸机相关性肺炎诊断价值的系统评价.中国呼吸与危重监护杂志, 2013, 12:258-263.

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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