The Value of Lp-PLA2 as a Biomarker for the Diagnosis of Plaque Stability in Atherosclerosis: A Meta-Analysis.

Background & Objective: Lipoprotein-associated phospholipase A2 (Lp-PLA2), secreted by inflammatory cells within atherosclerosis lesions, has emerged as a promising biomarker linked to plaque stability. This meta-analysis aims to synthesize current evidence on the diagnostic value of Lp-PLA2 as a biomarker of atherosclerotic plaque stability. Methods: Literature were searched from PubMed, Cochrane, Embase, ScienceDirect, SinoMed, Wanfang, and CNKI databases. QUADAS-2 scale was used for quality assessment. Forest plots displayed the sensitivity, specificity, and pooled effects of each study. Clinical applicability of the meta-analysis results was evaluated using positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and diagnostic score. Publication bias was analyzed using Deeks' funnel plot. Results: The pooled results from 22 studies (1110 stable plaque cases and 1298 unstable plaque cases) demonstrate that Lp-PLA2 exhibits significant diagnostic accuracy for plaque stability assessment. The pooled sensitivity was 0.85 (95% CI: 0.80-0.89), specificity was 0.80 (95% CI: 0.74-0.85), and the area under the ROC curve (AUC) was 0.89 (95% CI: 0.86-0.92). The PLR was 4.23 (95% CI: 3.24-5.52), the NLR was 0.19 (95% CI: 0.14-0.25), diagnostic score was 3.12 (95% CI: 2.69-3.54) and DOR was 22.55 (95% CI: 14.79-34.37). Significant heterogeneity might be induced by plaque location (I2 = 75%) and plaque formation criteria (I2 = 77%). Conclusions: Lp-PLA2 is a valuable biomarker for diagnosing plaque stability in atherosclerosis, with high diagnostic accuracy across various vascular territories.