Diagnostic value of the soluble triggering receptor expressed on myeloid cells-1 in bacterial infection: a meta-analysis
- 398 Downloads
To evaluate the accuracy of the soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) as a diagnostic test for bacterial infection.
Meta-analysis of 13 diagnostic studies.
Medline; Embase; Web of Science (from January 1966 to January, update to August 2008); and Cochrane Controlled Clinical Trials Register Database (through first quarter 2008).
Measurements and results
A meta-analysis of all 73 studies was performed. Thirteen studies fulfilled the inclusion criteria (980 patients, 557 patients with bacterial infection, 423 with non-bacterial infection); global prevalence was 56.8%. The global sensitivity was 0.82 (95% confidence interval CI, 0.68–0.90), the specificity was 0.86 (95% CI, 0.77–0.91), the positive likelihood ratio (PLR) was 5.66 (95% CI, 3.41–9.38), the negative likelihood ratio (NLR) was 0.21 (95% CI, 0.12–0.40), and the diagnostic odds ratio (DOR) was 26.35 (95% CI, 10.32–67.28). The area under the curve of the summary receiver operator characteristic (SROC) was 0.86 (95% CI, 0.77–0.91), with a Q point value of 0.84. The sensitivity of the sTREM-1 assay for diagnosis of urinary tract infection was low (0.18, 95% CI, 0.05–0.51).
sTREM-1 represents a reliable biological marker of bacterial infection, but it may be not a sufficient biological marker for infection of the urinary tract as a result of its low sensitivity. Whether sTREM-1 guidance can reduce antibiotic use as well as the measurement of sTREM-1 in different types of infection will require additional prospective studies.
KeywordsTREM1 protein Human Bacterial infection Diagnostic test Biological marker Meta-analysis
Conflict of interest statement
The authors have no conflicts of interest or financial disclosures to declare.
- 6.Reinhart K, Meisner M, Brunkhorst FM (2006) Markers for sepsis diagnosis: what is useful? Crit Care Clin 22:503–519, ix–xGoogle Scholar
- 8.Gibot S, Kolopp-Sarda MN, Bene MC, Cravoisy A, Levy B, Faure GC, Bollaert PE (2004) Summaries for patients. A possible new test for diagnosing sepsis. Ann Intern Med 141:146Google Scholar
- 20.Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. Br Med J 315:629–634Google Scholar
- 22.Tejera A, Santolaria F, Diez ML, Aleman-Valls MR, Gonzalez-Reimers E, Martinez-Riera A, Milena-Abril A (2007) Prognosis of community acquired pneumonia (CAP): value of triggering receptor expressed on myeloid cells-1 (TREM-1) and other mediators of the inflammatory response. Cytokine 38:117–123PubMedCrossRefGoogle Scholar
- 28.How CK, Chern CH, Wu MF, Wang LM, Huang CI, Lee CH, Hsieh SL (2007) Expression of the triggering receptor expressed on myeloid cells-1 mRNA in a heterogeneous infected population. Int J Clin Pract. doi: 10.1111/j.1742-1241.2006.01193.x
- 32.Determann RM, Millo JL, Gibot S, Korevaar JC, Vroom MB, van der Poll T, Garrard CS, Schultz MJ (2005) Serial changes in soluble triggering receptor expressed on myeloid cells in the lung during development of ventilator-associated pneumonia. Intensive Care Med 31:1495–1500PubMedCrossRefGoogle Scholar
- 38.Kofoed K, Andersen O, Kronborg G, Tvede M, Petersen J, Eugen-Olsen J, Larsen K (2007) Use of plasma C-reactive protein, procalcitonin, neutrophils, macrophage migration inhibitory factor, soluble urokinase-type plasminogen activator receptor, and soluble triggering receptor expressed on myeloid cells-1 in combination to diagnose infections: a prospective study. Crit Care 11:R38PubMedCrossRefGoogle Scholar
- 39.Yun SS, Jin HL, Eun MC, Jung HC (2007) Diagnostic utility of pleural fluid soluble triggering receptor expressed on myeloid cells 1 protein in patients with exudative pleural effusion. Tuberc Respir Dis 62:499–505Google Scholar
- 44.Wong-Baeza I, Gonzalez-Roldan N, Ferat-Osorio E, Esquivel-Callejas N, Aduna-Vicente R, Arriaga-Pizano L, Astudillo-de la Vega H, Villasis-Keever MA, Torres-Gonzalez R, Estrada-Garcia I, Lopez-Macias C, Isibasi A (2006) Triggering receptor expressed on myeloid cells (TREM-1) is regulated post-transcriptionally and its ligand is present in the sera of some septic patients. Clin Exp Immunol 145:448–455PubMedCrossRefGoogle Scholar
- 47.Stuck AE, Rubenstein LZ, Wieland D (1998) Bias in meta-analysis detected by a simple, graphical test. Asymmetry detected in funnel plot was probably due to true heterogeneity. Br Med J 316:469 Author reply 470–461Google Scholar
- 48.Vandenbroucke JP (1998) Bias in meta-analysis detected by a simple, graphical test. Experts’ views are still needed. Br Med J 316:469–470 Author reply 470–471Google Scholar
- 49.Song F, Eastwood AJ, Gilbody S, Duley L, Sutton AJ (2000) Publication and related biases. Health Technol Assess 4:1–115Google Scholar