Diagnostic and prognostic value of Ang-2 in ARDS: a systemic review and meta-analysis

ABSTRACT

Background

To investigate the diagnostic and prognostic value of angiopoietin-2 (Ang-2) for acute respiratory distress syndrome (ARDS).

Methods

Seven databases (4 English and 3 Chinese databases) were searched, the quality was evaluated by QUADAS-2 and GRADE profile. The bivariate model was employed to combine area under the curve (AUC), pooled sensitivity (pSEN) and pooled specificity (pSPE), the Fagan’s nomogram was employed for evaluating clinical utility. This study was registered in PROSPERO (NO.CRD42022371488).

Results

18 eligible studies comprising 27 datasets (12 diagnostic and 15 prognostic datasets) were included for meta-analysis. For diagnostic analysis, Ang-2 yielded an AUC of 0.82, with a pSEN of 0.78 and a pSPE of 0.74; in clinical utility analysis, a pretest probability of 50% regulated the post probability positive (PPP) of 75% and the post probability negative (PPN) of 23%. In prognostic analysis, Ang-2 yielded an AUC of 0.83, with a pSEN of 0.69, a pSPE of 0.81, and good clinical utility (a pretest probability of 50% regulated the PPP of 79% and the PPN of 28%). Heterogeneity existed in both diagnostic and prognostic analysis.

Conclusions

Ang-2 demonstrates promising diagnostic and prognostic capabilities as a noninvasive circulating biomarker for ARDS, especially in the Chinese population. It is advisable to dynamically monitor Ang-2 in critically ill patients both suspected and with confirmed ARDS.

KEYWORDS:

• Angiopoietin-2 (Ang-2)
• diagnosis
• mortality
• acute respiratory distress syndrome (ARDS)
• meta-analysis

Abbreviations

Ang-2	=	angiopoietin-2
ALI	=	acute lung injury
ARDS	=	acute respiratory distress syndrome
AECC	=	American-European consensus conference
AUC	=	area under the curve
CSCCM	=	Chinese Society of Critical Care Medicine
GRADE	=	The Grading of Recommendations, Assessment, Development, and Evaluation
QUADAS-2	=	The Quality Assessment of Diagnostic Accuracy Studies 2
95% CI	=	95% confidence interval
DOR	=	diagnostic odds ratio
pSEN	=	pooled sensitivity
pSPE	=	pooled specificity
pPLR	=	pooled positive likelihood ratio
pNLR	=	pooled negative likelihood ratio
PPP	=	post probability positive
PPN	=	post probability negative
ROC	=	receiver operating characteristic curve
SROC	=	summary receiver operating characteristic curve

Authors contributions

Q Zeng, and F Wen conceived and designed the study; Q Zeng, G Huang, and S Li. collected and analyzed the data; Q Zeng, G Huang, and S Li, prepared the original draft; F Wen provided funding support; all authors approved the manuscript.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17476348.2023.2230883.

Additional information

Funding

This work was funded by the 1·3·5 project for disciplines of excellence, West China Hospital, Sichuan University [grant numbers ZYGD18006, ZYJC18012].