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Systematic Review and Meta-Analysis of Diagnostic Biomarkers for Pediatric Pneumonia
Journal of the Pediatric Infectious Diseases Society ( IF 3.2 ) Pub Date : 2021-07-02 , DOI: 10.1093/jpids/piab043
Lourdes Cynthia Gunaratnam 1 , Joan L Robinson 1 , Michael T Hawkes 1, 2, 3, 4, 5
Affiliation  

Abstract
Background
Pneumonia causes significant morbidity and mortality in children worldwide, especially in resource-poor settings. Accurate identification of bacterial etiology leads to timely antibiotic initiation, minimizing overuse, and development of resistance. Host biomarkers may improve diagnostic sensitivity and specificity. We assessed the ability of biomarkers to correctly identify bacterial pneumonia in children who present with respiratory distress.
Methods
A librarian-directed search was conducted of MEDLINE, EMBASE, CENTRAL, Global Health, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov to May 2020 with no language restriction. Included studies compared a diagnostic biomarker in children with bacterial pneumonia to those with nonbacterial respiratory distress.
Results
There were 31 observational studies of 23 different biomarkers. C-reactive protein (CRP), procalcitonin (PCT), white blood cell (WBC) count, and erythrocyte sedimentation rate (ESR) were the biomarkers with sufficient data for meta-analysis. Meta-analysis revealed that CRP and PCT best differentiated bacterial from viral pneumonia with CRP summary AUROC (area under the receiver operating characteristic curve) 0.71 (0.69-0.73), Youden index 53 mg/L, sensitivity 0.70 (0.68-0.78), and specificity 0.64 (0.58-0.68) and PCT summary AUROC 0.70 (0.67-0.74), Youden index 0.59 ng/mL, sensitivity 0.69 (0.65-0.77), and specificity 0.64 (0.60-0.68). WBC and ESR did not perform as well. Nineteen other inflammatory and immunologic biomarkers were identified including CRP/mean platelet value, neutrophil/leukocyte ratio, interleukin 6, and interferon-alpha, with sensitivities from 60% to 85% and specificities from 76% to 83%.
Conclusion
CRP and PCT performed better than WBC and ESR but had suboptimal sensitivity. Some less well-studied novel biomarkers appear to have promise particularly in combination.


中文翻译:

小儿肺炎诊断生物标志物的系统评价和荟萃分析

摘要
背景
肺炎导致全世界儿童的发病率和死亡率很高,尤其是在资源贫乏的环境中。准确识别细菌病因可以及时启动抗生素,最大限度地减少过度使用和耐药性的发展。宿主生物标志物可以提高诊断的敏感性和特异性。我们评估了生物标志物在出现呼吸窘迫的儿童中正确识别细菌性肺炎的能力。
方法
在 2020 年 5 月之前对 MEDLINE、EMBASE、CENTRAL、Global Health、世界卫生组织国际临床试验注册平台和 ClinicalTrials.gov 进行了图书馆员指导的搜索,没有语言限制。纳入的研究比较了细菌性肺炎儿童与非细菌性呼吸窘迫儿童的诊断生物标志物。
结果
对 23 种不同生物标志物进行了 31 项观察性研究。C 反应蛋白 (CRP)、降钙素原 (PCT)、白细胞 (WBC) 计数和红细胞沉降率 (ESR) 是具有足够数据进行荟萃分析的生物标志物。荟萃分析显示,CRP 和 PCT 最能区分细菌性和病毒性肺炎,CRP 总结 AUROC(受试者工作特征曲线下面积)0.71 (0.69-0.73),约登指数 53 mg/L,敏感性 0.70 (0.68-0.78),以及特异性 0.64 (0.58-0.68) 和 PCT 摘要 AUROC 0.70 (0.67-0.74)、约登指数 0.59 ng/mL、敏感性 0.69 (0.65-0.77) 和特异性 0.64 (0.60-0.68)。WBC 和 ESR 表现不佳。确定了 19 种其他炎症和免疫生物标志物,包括 CRP/平均血小板值、中性粒细胞/白细胞比率、白细胞介素 6 和干扰素-α,
结论
CRP 和 PCT 的表现优于 WBC 和 ESR,但灵敏度欠佳。一些研究较少的新型生物标志物似乎特别有前景。
更新日期:2021-07-02
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