(165) Diagnosis of intrauterine inflammation in women with PPROM using cervicovaginal interleukin-6: systematic review and meta-analysis

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.

Study Design:

A systematic literature search was undertaken using Embase, SCOPUS, PubMed, and the Cochrane library from their inception to Feb 2022.  Prospective and retrospective studies evaluating cervicovaginal interleukin-6 (IL-6) concentrations, in women diagnosed with PPROM at less than 37weeks of gestation, were included.  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 and 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. 

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 (figure 1).   Figure 2 shows 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.

Conclusion:

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.