Inflammatory markers in cord blood or maternal serum for early detection of neonatal sepsis-a systemic review and meta-analysis
Inflammatory markers in cord blood or maternal serum for early detection of neonatal sepsis-a systemic review and meta-analysis
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DOI：
10.1038/jp.2013.186
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发表时间：
2014-04-01
影响因子：
2.9
通讯作者：
Lee, C-C
中科院分区：
文献类型：
--
作者：
Su, H.;Chang, S-S;Lee, C-C
目的：对母体血清或脐带血中炎性标志物对早发性新生儿败血症（EONS）诊断价值的证据进行定量评价。研究设计：我们检索了多个数据库中截至2013年3月发表的研究，这些研究评价了降钙素原（PCT）、C反应蛋白（CRP）和白细胞介素-6（IL-6）的诊断性能，以及用于诊断EONS的脐带血或母体血清中的白细胞计数（白色血细胞，WBC）。我们总结了测试的性能特点与使用森林图，分层汇总接收器操作特征曲线和双变量随机效应models.RESULT：我们的搜索确定了3874引文，其中15项研究评估2178例疑似新生儿感染被纳入分析。脐带血中IL-6的合并阳性似然比（LR+）为9.47（95%置信区间：3.86至23.3），脐带血中PCT的LR+为5.72（1.56至21.0），母体血清中IL-6的LR+为5.47（2.10至14.2），可作为有效的纳入试验。IL-6在脐带血中的LR -为0.10（0.05至0.21）和PCT在脐带血中的LR -为0.20（0.12-0.37），可以作为一个有用的排除测试合格。结论：IL-6和PCT可作为脐血EONS的可靠的排除和纳入工具。对于母体血清，仅IL-6似乎足以用于纳入诊断。可能需要一项干预性研究来回答增加这些检查是否会改善EONS患者的结局。
OBJECTIVE: To perform a quantitative review of the evidence on the diagnostic value of inflammatory markers in maternal serum or umbilical cord blood for the diagnosis of early-onset neonatal sepsis (EONS).STUDY DESIGN: We searched multiple databases for studies published through March 2013 that evaluated the diagnostic performance of procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6), and leukocyte count (white blood cell, WBC) in either umbilical cord blood or maternal serum for diagnosis of EONS. We summarized test performance characteristics with the use of forest plots, hierarchical summary receiver operating characteristic curves and bivariate random effects models.RESULT: Our search identified 3874 citations, of which 15 studies evaluating 2178 episodes of suspected neonatal infection were included for analysis. IL-6 in cord blood with a pooled-positive likelihood ratio (LR+) of 9.47 (95% confidence interval: 3.86 to 23.3), PCT in cord blood with a LR+ of 5.72 (1.56 to 21.0) and IL-6 in maternal serum with a LR+ of 5.47 (2.10 to 14.2) can be qualified as a valid rule-in test. IL-6 in cord blood with a LR - of 0.10 (0.05 to 0.21) and PCT in cord blood with a LR - of 0.20 (0.12-0.37) can be qualified as a useful rule-out test. Either CRP or WBC was inadequate for diagnosis of EONS.CONCLUSION: For cord blood sample, IL-6 or PCT can be used as reliable rule-in and rule-out tool. For maternal serum, only IL-6 appeared to be sufficient for rule-in diagnosis. An interventional study may be needed to answer whether the addition of these tests will improve the outcome of patients with EONS.