Table 3 Summary of findings table
Maternal inflammatory markers for chorioamnionitis in preterm prelabour rupture of membranes(PPROM): a systematic review and meta-analysis of diagnostic test accuracy studies | |||||||||
|---|---|---|---|---|---|---|---|---|---|
Question | In pregnant women with PPROM, can maternal serum inflammatory markers be used to diagnose chorioamnionitis? | ||||||||
Population | Pregnant women with PPROM | ||||||||
Studies | Any study design where the index test is compared against the reference standard | ||||||||
Index test | C-reactive protein (CRP), procalcitonin (PCT) and interleukin 6 (IL6) assessed in maternal serum before delivery | ||||||||
Reference standard | Histologic chorioamnionitis (HCA) and/ or funisitis | ||||||||
Prevalence of disease | Median prevalence 50% (range 21–70%, IQR 38 to 57%) 23 studies with a total of 1717 pregnant women with PPROM, 902 of whom had HCA/funisitis | ||||||||
Quality | Included studies were generally of poor quality with all studies at high risk of bias in at least one domain (QUADAS-2). There were few studies with high applicability concerns and only in the patient selection domain. | ||||||||
Index test | Studies (participants) | Sensitivity (95% CI) | Specificity (95% CI) | Heterogeneity | Sensitivity analysis | Interpretation: assuming a patient population of 100 pregnant women with PPROM and prevalence of 50%* | |||
Correctly diagnosed cases (TP) | Missed cases (FN) | Unnecessary interventions (FP) | True reassurance of no disease (TN) | ||||||
CRP at 20 mg/L†| 5 (252) | 59% (47.7–69.0) | 83% (74.0–89.2) | High heterogeneity despite common cut-off |  | 30 | 21 | 9 | 42 |
CRP at all cut-offs‡ | 17 (1404) | 59% (52.0–67.6) | 80% | Partially explained by nature of cut-off used, sampling interval, risk of bias in the patient selection domain and type of CRP assay | Sensitive to gestational age range for study inclusion and year of publication | 30 | 20 | 10 | 40 |
PCT at all cut-offs‡ | 6(231) | 56% (49.9–68.9) | 80% | Partially explained by nature of cut-off used and risk of bias in the patient selection domain of QUADAS-2 | Sensitive to applicability concerns score in the patient selection domain of QUADAS-2 | 28 | 22 | 10 | 40 |
IL6 at all‡ cut-offs | 5 (299) | 52% (50.0–85.8) | 80% | Partially explained by sampling interval | Sensitive to gestational age range for study | 26 | 24 | 10 | 40 |