Value of bronchial amylase level for predicting ventilator associated pneumonia in intubated adults: a systematic review and meta-analysis

Abstract

Background: The ability of bronchial amylase level for predicting ventilator associated pneumonia (VAP) has been extensively studied with conflicting results. This meta-analysis aimed to explore the value of bronchial amylase for predicting VAP in intubated adults. Methods: PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched up to November 2023. The diagnostic odds ratio (DOR), sensitivity, and specificity were calculated. The summary receiver operating characteristic curve was estimated, and the area under the curve (AUROC) was calculated. Results: Overall, six studies including 769 patients were included in this review, of whom 273 (36%) were developed VAP. The cutoff values of bronchial amylase level were ranged from 8.1 U/L to 4681.5U/L. Heterogeneity between studies was assessed with an overall Q = 1.99, I2 = 0, and P = 0.185, The pooled sensitivity and specificity for the overall population were 0.78 [95% confidence interval (CI) 0.67–0.86] and 0.75(95% CI 0.56–0.88) respectively. The DOR was 11(95% CI 3.0–40.0). The pooled AUROC was 0.83 (95%CI 0.80–0.86). Conclusions: The bronchial amylase is a helpful marker for predicting VAP in intubated adults. However, it cannot be recommended as the single definitive test for VAP, but rather it must be interpreted in context with information from careful medical history, physical examination, and when feasible, microbiological assessment.