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

ABSTRACTABSTRACTBackground 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)diagnosismortalityacute respiratory distress syndrome (ARDS)meta-analysis Abbreviations Ang-2angiopoietin-2ALIacute lung injuryARDSacute respiratory distress syndromeAECCAmerican-European consensus conferenceAUCarea under the curveCSCCMChinese Society of Critical Care MedicineGRADEThe Grading of Recommendations, Assessment, Development, and EvaluationQUADAS-2The Quality Assessment of Diagnostic Accuracy Studies 295% CI95% confidence intervalDORdiagnostic odds ratiopSENpooled sensitivitypSPEpooled specificitypPLRpooled positive likelihood ratiopNLRpooled negative likelihood ratioPPPpost probability positivePPNpost probability negativeROCreceiver operating characteristic curveSROCsummary receiver operating characteristic curveAuthors contributionsQ 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 interestThe 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 disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.Supplemental dataSupplemental data for this article can be accessed online at https://doi.org/10.1080/17476348.2023.2230883.Additional informationFundingThis work was funded by the 1·3·5 project for disciplines of excellence, West China Hospital, Sichuan University [grant numbers ZYGD18006, ZYJC18012].