Biomarkers in lower respiratory tract samples in the diagnosis of ventilator-associated pneumonia: a systematic review
Abstract
Background Ventilator-associated pneumonia (VAP) is the most common intensive care unit-acquired infection, yet its diagnosis is complicated by the lack of reliable diagnostic criteria and validated biomarkers. Due to the compartmentalisation of the immune response, host proteins in respiratory tract samples are more likely than serum proteins to accurately identify VAP. However, a reliable biomarker is still missing and it is generally agreed that >90% sensitivity and specificity are required for the introduction of a VAP biomarker into clinical routine. Methods A structured database search was performed to identify publications aimed at deriving or verifying human respiratory tract VAP biomarkers. The results were screened by two independent reviewers and summarised using statistical and narrative synthesis. Results 40 articles were identified, focusing on 29 unique biomarkers with clinical and microbiological diagnoses of VAP as the reference standard. The most frequently studied biomarker was soluble triggering receptor expressed on myeloid cell 1 (sTREM-1) (n=16), followed by various interleukins (n=7), neutrophil-related proteins (n=8) and amylase as a surrogate for microaspiration (n=4). The target accuracy of >90% specificity and sensitivity for VAP was reported in four publications on sTREM-1, one on pentraxin-3 (PTX3) and one on heparin-binding protein (HBP). Meta-analysis of sTREM-1 resulted in a sensitivity of 78% (95% CI 61–89%) and specificity of 76% (95% CI…
How strong is the evidence?
Evidence Hub reads this as a systematic review. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 16 participants or records.
Read the paper
Related studies
- Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials
- A new aging measure captures morbidity and mortality risk across diverse subpopulations from NHANES IV: A cohort study
- Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study
- Are noise and air pollution related to the incidence of dementia? A cohort study in London, England
- The Dietary Approaches to Stop Hypertension (DASH) diet, Western diet, and risk of gout in men: prospective cohort study
- Incidence of shoulder dislocations in the UK, 1995–2015: a population-based cohort study
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.