A Systematic Review of Diagnostic Biomarkers of COPD Exacerbation

• Published in: PloS one 2016-07, Vol.11 (7), p.e0158843
• Main Authors: Chen, Yu-Wei Roy, Leung, Janice M, Sin, Don D
• Format: Article
• Language: English
• Subjects: Aged; Airway management; Analysis; Area Under Curve; Bioindicators; Biological markers; Biology and Life Sciences; Biomarkers; Biomarkers - blood; C-reactive protein; C-Reactive Protein - metabolism; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Cross-Sectional Studies; Diagnosis; Diagnostic systems; Diagnostic tests; Disease Progression; Documents; Female; Heart; Hospitals; Humans; Interleukin; Interleukin 6; Interleukin-6 - blood; Laboratories; Longitudinal Studies; Lung diseases; Male; Medical diagnosis; Medicine; Medicine and Health Sciences; Middle Aged; Obstructive lung disease; Patients; People and Places; Plasma; Practice Guidelines as Topic; Pulmonary Disease, Chronic Obstructive - blood; Pulmonary Disease, Chronic Obstructive - diagnosis; Quality assessment; Replication; Research and Analysis Methods; Risk factors; ROC Curve; Studies; Systematic review; Tumor markers; Tumor necrosis factor; Tumor Necrosis Factor-alpha - blood; Tumor necrosis factor-α
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0158843

The aims of this systematic review were to determine which blood-based molecules have been evaluated as possible biomarkers to diagnose chronic obstructive pulmonary disease (COPD) exacerbations (AECOPD) and to ascertain the quality of these biomarker publications. Patients of interest were those that have been diagnosed with COPD. MEDLINE, EMBASE, and CINAHL databases were searched systematically through February 2015 for publications relating to AECOPD diagnostic biomarkers. We used a modified guideline for the REporting of tumor MARKer Studies (mREMARK) to assess study quality. Additional components of quality included the reporting of findings in a replication cohort and the use of receiver-operating characteristics area-under-the curve statistics in evaluating performance. 59 studies were included, in which the most studied biomarkers were C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). CRP showed consistent elevations in AECOPD compared to control subjects, while IL-6 and TNF-α had variable statistical significance and results. mREMARK scores ranged from 6 to 18 (median score of 13). 12 articles reported ROC analyses and only one study employed a replication cohort to confirm biomarker performance. Studies of AECOPD diagnostic biomarkers remain inconsistent in their reporting, with few studies employing ROC analyses and even fewer demonstrating replication in independent cohorts.