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      Serum interleukin-6 in the diagnosis of bacterial infection in cirrhotic patients : A meta-analysis

      review-article
      , MM, , MB, , MD, PhD, , MM
      Medicine
      Wolters Kluwer Health
      bacterial infection, cirrhosis, interleukin-6, meta-analysis

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          Abstract

          Background:

          The diagnostic accuracy of interleukin-6 (IL-6) in predicting bacterial infection in cirrhotic patients remains unclear. The aim of this meta-analysis is to explore the potential diagnostic value of IL-6 in cirrhotic patients.

          Methods:

          We systematically searched PubMed, Embase (via OvidSP), Web of Science, the Cochrane Library, and Scopus for studies published from inception to October 2015. Studies were enrolled if they included assessment of the accuracy of IL-6 in the diagnosis of bacterial infection in cirrhotic patients and provided sufficient data to construct a 2 × 2 contingency table.

          Results:

          Totally, 535 studies were searched in the initial database and finally 6 studies involving 741 patients were included for the final analysis. The pooled sensitivity, specificity and diagnostic odds ratio were 0.85 (95% confidence interval [CI], 0.64–0.94), 0.91 (95% CI, 0.80–0.96) and 52.89 (95% CI, 15.21–183.86), respectively. The pooled positive likelihood ratio was 8.99 (95% CI, 4.13–19.55) and the pooled negative likelihood ratio was 0.17 (95% CI, 0.07–0.43). The area under the receiver operating characteristic curve was 0.94 (95% CI, 0.92–0.96).

          Conclusion:

          This meta-analysis suggests IL-6 has a high diagnostic value for the differentiation of bacterial infection in patients with cirrhosis.

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          Most cited references17

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          • Abstract: found
          • Article: not found

          Management of bacterial infections in cirrhosis.

          Bacterial infections are very frequent in advanced cirrhosis and become the first cause of death of these patients. Despite numerous experimental data and significant advances in the understanding of the pathogenesis of sepsis in cirrhosis, the outcome remains poor. Classical diagnostic parameters such as C-reactive protein and SIRS criteria have less diagnostic capacity in the cirrhotic population, often delaying the diagnosis and the management of bacterial infection. Prompt and appropriate empirical antibiotic treatment of infection and early resuscitation of patients with severe sepsis or septic shock are essential in determining patient's outcome. A strategy of careful restriction of prophylactic antibiotics to the high-risk populations could reduce the spread of multidrug resistant bacteria. This review is focused on the currently recommended diagnostic, therapeutic and prophylactic strategies for bacterial infections in the cirrhotic population. Copyright © 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
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            Cirrhosis as a risk factor for sepsis and death: analysis of the National Hospital Discharge Survey.

            The unfavorable influence of cirrhosis on survival in the critically ill has been supported by several single-center reports. Variations in case mix, the technological capabilities of individual facilities, and differences in organizational staffing and structure could limit the extrapolation and generalization of these data to other institutions. To assess the impact of a diagnosis of cirrhosis on outcomes of sepsis, sepsis-related mortality, and respiratory failure in hospitalized patients, we analyzed data from the National Hospital Discharge Survey (NHDS) from 1995 to 1999 to determine its national consequence. Secondary analysis of an existing national database. Based on NHDS estimates, 175 million hospital discharges occurred during the 5-year period of study. One percent (1.7 million) of these hospitalizations involved a diagnosis of cirrhosis. None. After adjustments for age, race, and gender, cirrhotic individuals are significantly more likely to die while hospitalized (adjusted risk ratio [RR], 2.7; 95% confidence interval [CI], 2.3 to 3.1), to have hospitalizations associated with sepsis (adjusted RR, 2.6; 95% CI, 1.9 to 3.3), and to die from sepsis (adjusted RR, 2.0; 95% CI, 1.3 to 2.6). Additionally, cirrhosis is associated with an increased RR for acute respiratory failure (adjusted RR, 1.4; 95% CI, 1.1 to 1.8) and death from acute respiratory failure (adjusted RR, 2.6; 95% CI, 1.5 to 3.6). In this national database of hospital discharge information, a diagnosis of cirrhosis is strongly associated with an increased risk of sepsis, acute respiratory failure, sepsis-related mortality, and acute respiratory failure-related mortality.
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              Serum procalcitonin and C-reactive protein levels as markers of bacterial infection in patients with liver cirrhosis: a systematic review and meta-analysis.

              The diagnostic value of procalcitonin (PCT) for patients with liver cirrhosis is unclear. We searched the PubMed, EMBASE, and Cochrane databases for studies published through December 2013 that evaluated the diagnostic performance of PCT for patients with acute or chronic liver disease with suspected systemic infection. We summarized the test performance characteristics by using forest plots, hierarchical summary receiver operating characteristic curves, and bivariate random effects models. Our search identified 230 citations, of which 10 diagnostic studies that evaluated 1144 patients and 435 bacterial infection episodes (32.1%) were ultimately included for analysis. The bivariate pooled sensitivity estimates were 79% (95% confidence interval [CI]: 64%-89%) for PCT tests and 77% (95% CI: 69%-84%) for C-reactive protein (CRP) tests. Pooled specificity estimates were higher for both PCT and CRP tests (PCT, 89% [95% CI: 82%-94%]; CRP, 85% [95% CI: 76%-90%]). The positive likelihood ratio for PCT (LR+, 7.38, 95% CI: 4.70-11.58) was sufficiently high to qualify PCT as a rule-in diagnostic tool, and the negative likelihood ratio for CRP was sufficiently low to qualify CRP as an acceptable rule-out diagnostic tool (LR- 0.23, 95% CI: 0.13-0.41) in patients with no signs of infection. Available clinical evidence showed that PCT has comparable accuracy to CRP for the diagnosis of systemic infection in patients with liver cirrhosis. Compared with patients with normal liver function, both PCT and CRP tests have acceptable accuracy for diagnosing bacterial infection among patients with liver cirrhosis.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                October 2016
                14 October 2016
                : 95
                : 41
                : e5127
                Affiliations
                Liver Research Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
                Author notes
                []Correspondence: Su Lin, Liver Research Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (e-mail: sumer5129@ 123456fjmu.edu.cn ).
                Article
                05127
                10.1097/MD.0000000000005127
                5072964
                27741137
                f8230d62-b8c1-4628-b106-f1fdaa55e49c
                Copyright © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All rights reserved.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0

                History
                : 9 May 2016
                : 27 July 2016
                : 22 September 2016
                Categories
                4900
                Research Article
                Systematic Review and Meta-Analysis
                Custom metadata
                TRUE

                bacterial infection,cirrhosis,interleukin-6,meta-analysis

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