不同检测指标预测ICU成年人患者血流感染诊断价值的网状Meta分析  

The diagnostic value of bloodstream infection in adult ICU patients predicted by different detection indicators:a network Meta-analysis

作　　者：王喆 胡雁[2] 李春雷 杨马裔 Wang Zhe;Hu Yan;Li Chunlei;Yang Mayi(Department of Operating Room,Fudan University Affiliated Zhongshan Hospital,Shanghai 200032,China;School of Nursing,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院手术室,上海200032 [2]复旦大学护理学院,上海200032

出　　处：《中国实用护理杂志》2024年第27期2118-2128,共11页Chinese Journal of Practical Nursing

基　　金：复旦大学-复星护理科研基金(FNF202201)。

摘　　要：目的使用网状Meta分析比较不同检测指标对ICU成年人患者血流感染的预测价值,为临床早期诊断患者血流感染提供循证依据。方法计算机检索Cochrane Library、PubMed、Embase、CINAHL、Web of Science、中国知网、维普、万方、中国生物医学文献数据库,收集所有关于不同检测指标预测ICU成年人患者发生血流感染的试验研究,检索时限为建库至2023年7月9日;由2名研究者按照文献纳入和排除标准独立检索文献、筛选文献,并严格评价纳入文献的质量,提取资料,使用Revman5.4软件进行Meta分析。结果最终纳入13篇文献。网状Meta分析排序结果显示,在不同检测指标中,降钙素原(PCT)、C反应蛋白(CRP)与白介素6(IL-6)联合检测灵敏度、阴性预测值和准确度的累积排序曲线下面积最高(85.08%、90.41%、79.39%),PCT、超敏C反应蛋白(hs-CRP)与IL-6联合检测特异度、阳性预测值的累积排序概率曲线下面积最高(68.47%、77.92%);聚类分析结果显示,PCT+hs-CRP+IL-6与PCT+CRP+IL-6均可作为临床早期预测重症患者发生血流感染的检测指标。结论PCT+CRP/hs-CRP+IL-6可作为ICU成年人患者诊断血流感染的的预测指标,单项检测中肾上腺髓质素前体可能是未来研究的方向,但因样本含量较少,上述结论尚有待于更多大样本、高质量的研究加以验证。Objective Network Meta-analysis was used to compare the predictive value of different detection indicators for bloodstream infection in ICU adult patients,providing evidence-based basis for early clinical diagnosis of bloodstream infection in patients.Methods Cochrane Library,PubMed,Embase,CINAHL,Web of Science,China National Knowledge Infrastructure(CNKI),VIP,Wanfang database and SinoMed were searched by computer.All the experimental studies on different detection indicators for predicting bloodstream infection in ICU adult patients were collected.The retrieval time limit was from the establishment of the database to July 9,2023.Two researchers independently searched and screened the literature according to the literature inclusion and exclusion criteria,strictly evaluated the quality of the included literature,extracted data,and used Revman5.4 software for Meta-analysis.Results A total of 13 studies were included.The ranking results of network Meta-analysis showed that among different detection indicators,procalcitonin(PCT),C-reactive protein(CRP),combined with(IL-6)had the highest area under the cumulative rank probability curve for sensitivity,negative predictive value and accuracy(85.08%,90.41%,79.39%).PCT,hypersensitive-C-reactive protein(hs-CRP)combined with IL-6 had the highest area under the cumulative rank probability curve of specificity and positive predictive value(68.47%,77.92%).The results of cluster analysis showed that PCT+hs-CRP+IL-6 and PCT+CRP+IL-6 were the farthest distance from the origin compared with other detection indicators.Conclusions PCT+CRP/hs-CRP+IL-6 can be used as a predictor for the diagnosis of bloodstream infection in ICU adult patients.In a single detection,pro-adrenomendullin may be the direction of future research,but due to the small sample size,the above conclusions need to be verified by more large sample and high quality studies.

关 键 词：重症监护病房 预测 META分析 检测指标 血流感染 诊断价值 

分 类 号：R515[医药卫生—内科学]