Inflammatory Biomarkers Are Inaccurate Indicators of Bacterial Infection on Admission in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease-A Systematic Review and Diagnostic Accuracy Network Meta-Analysis

Piroska Pázmány; Alexandra Soós; Péter Hegyi; Dóra Dohos; Szabolcs Kiss; Zsolt Szakács; Andrea Párniczky; András Garami; Zoltán Péterfi; Zsolt Molnár

doi:10.3389/fmed.2021.639794

Inflammatory Biomarkers Are Inaccurate Indicators of Bacterial Infection on Admission in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease-A Systematic Review and Diagnostic Accuracy Network Meta-Analysis

Front Med (Lausanne). 2021 Nov 18:8:639794. doi: 10.3389/fmed.2021.639794. eCollection 2021.

Authors

Piroska Pázmány^{1

2

3}, Alexandra Soós¹, Péter Hegyi^{1

3

4

5}, Dóra Dohos¹, Szabolcs Kiss^{1

3}, Zsolt Szakács^{1

4}, Andrea Párniczky^{1

3

6}, András Garami¹, Zoltán Péterfi⁷, Zsolt Molnár^{1

3

5

8

9}

Affiliations

¹ Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary.
² Department of General Medicine and Pulmonology, Heim Pál National Institute for Pediatrics, Budapest, Hungary.
³ Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary.
⁴ János Szentágothai Research Center, University of Pécs, Pécs, Hungary.
⁵ Centre for Translational Medicine, Semmelweis University, Faculty of Medicine, Budapest, Hungary.
⁶ Department of Gastroenterology, Heim Pál National Institute for Pediatrics, Budapest, Hungary.
⁷ Department of Internal Medicine, Medical School, University of Pécs, Pécs, Hungary.
⁸ Department of Anesthesiology and Intensive Therapy, Medical Faculty, Poznan University for Medical Sciences, Poznan, Poland.
⁹ Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Faculty of Medicine, Budapest, Hungary.

Abstract

Introduction: The value of inflammatory biomarkers in the diagnosis of bacterial infection induced acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is currently unclear. Our objective was to investigate the diagnostic accuracy of on-admission inflammatory biomarkers in differentiating bacterial origin in AECOPD. Methods: Systematic literature search was performed to include cross-sectional studies on AECOPD patients with microbiological culture results as gold standard, and at least one on-admission inflammatory biomarker determined from serum: C-reactive protein (CRP), procalcitonin (PCT), neutrophil/lymphocyte ratio, eosinophil percentage, CD64index; or sputum: neutrophil elastase, tumor necrosis factor alfa, interleukin-1-beta (IL-1b), interleukin-8, sputum color, as index tests. We ranked index tests by superiority indices in a network meta-analysis and also calculated pooled sensitivity and specificity. Results: Altogether, 21 eligible articles reported data on 2,608 AECOPD patients (44% bacterial). Out of the 14 index tests, sputum IL-1b showed the highest diagnostic performance with a pooled sensitivity of 74% (CI: 26-97%) and specificity of 65% (CI: 19-93%). Pooled sensitivity for CRP and PCT were: 67% (CI: 54-77%) and 54% (CI: 39-69%); specificity 62% (CI: 52-71%) and 71% (CI: 59-79%), respectively. Conclusion: Admission inflammatory biomarkers are inaccurate indicators of bacterial infection in AECOPD. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/#myprospero, identifier: 42020161301.

Keywords: acute exacerbation; bacterial infection; chronic objective pulmonary disease; diagnostic accuracy; inflammatory biomarker; meta-analysis; microbiological culture.

Publication types

Systematic Review