Diagnosis of Intrauterine Inflammation/Infection in Women with Preterm Prelabor Rupture of Membranes Using Cervicovaginal Interleukin-6 Concentrations: Systematic Review and Meta-Analysis

Abstract

Title: Diagnosis of intrauterine inflammation/infection in women with preterm prelabor rupture of membranes using cervicovaginal interleukin-6 concentrations: systematic review and meta-analysis Objective: To establish the diagnostic test accuracy of cervicovaginal interleukin-6 concentration in the detection of intraamniotic inflammation, in women with preterm prelabor rupture of membranes (PPROM) at less than 37 weeks of gestational age. Data sources: A systematic literature search was undertaken using Embase, SCOPUS, PubMed, and the Cochrane library from their inception to Feb 2022. Study eligibility criteria: Prospective and retrospective studies evaluating cervicovaginal interleukin-6 (IL-6) concentrations, in women diagnosed with PPROM at less than 37weeks of gestation, were included. Study appraisal and synthesis methods: Cervicovaginal IL-6 concentration was assessed as the index test for the prediction of intraamniotic inflammation. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was independently used by two reviewers to assess the quality of the studies. Forest plots for sensitivity and specificity with 95% CIs were constructed. Hierarchical summary receiver operating characteristic curves were constructed; quantitative data synthesis was performed using random-effects models. Diagnostic odds ratios were calculated to measure the global effectiveness of the diagnostic test. Heterogeneity was assessed using Cochran’s Q statistic, with p <0.10 denoting heterogeneity. Meta-regression was performed to assess the effect of 2 covariates. Publication bias could not be assessed given the limited number of studies. Results: Eighteen studies were retained for qualitative analysis, 14 were included in the meta-analysis. The study population included 1,655 women diagnosed with PPROM. According to the QUADAS-2 tool, all included studies were of poor quality. The area under the curve (AUC) for the diagnosis of intraamniotic inflammation and/or infection by cervicovaginal IL-6 was 0.838  0.035. The pooled diagnostic odds ratio of cervicovaginal IL-6 was found to be 10.74 (95% CI 5.45, 21.17). Based on the Cochran’s Q value of 88.03 (p = 0.00), a high degree of heterogeneity exists across studies. Conclusions: Cervicovaginal IL-6 has a DOR of 10.74 (95% CI 5.45, 21.17) in the detection of intrauterine inflammation/infection. Based on our results, cervicovaginal IL-6 seems to have a good diagnostic accuracy in the detection of intraamniotic inflammation/infection in women with PPROM.