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Human preterm premature rupture of membranes (PPROM) refers to the spontaneous rupture of fetal membranes before 37 weeks of gestation and prior to labor. Clinically, the decision to induce labor or continue expectant management must be balanced against the risk of infection, particularly chorioamnionitis. Early diagnosis is critical, as chorioamnionitis is associated with preterm birth and fetal (hypoxia and/or sepsis) and maternal (bacteremia, hemorrhage, and/or death) complications. Currently, no specific blood biomarker is routinely used, with only nonspecific parameters like C-reactive protein (CRP) and white blood cell (WBC) count available. This highlights the need to review and meta-analyze recent studies to summarize new maternal blood biomarkers and improve diagnostic performance. A meta-analysis was performed to assess the prognostic value of some current or new blood biomarkers in predicting histological or clinical chorioamnionitis in women after PPROM. A protocol was designed and registered with PROSPERO (CRD420251058686). Studies were chosen if they included women with PPROM who underwent blood biomarker measurements and histological evaluation of the fetal membranes or clinical assessment of chorioamnionitis. The quality of each study was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) criteria. Three databases (Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL)) were consulted. Of the 631 articles screened, 9 were finally selected for inclusion. The overall pooled sensitivity (Se) of CRP, WBC count, procalcitonin (PCT), and neutrophil-lymphocyte ratio (NLR) were respectively 71% (95% CIs of 60%-81%), 73% (95% CIs of 66%-79%), 83% (95% CIs of 68%-94%) and 75% (95% CIs of 68%-81%). The overall pooled specificity (Spe) of CRP, WBC, PCT, and NLR were respectively 75% (95% CIs of 73%-78%), 61% (95% CIs of 52%-63%), 41% (95% CIs of 10%-76%) and 82% (95% CIs of 61%-96). The area under the curve (AUC), obtained from receiver operating characteristic (ROC) curve analysis was 77%, 73%, 74%, and 77% for CRP, WBC count, PCT, and NLR, respectively. Evidently, no single biomarker currently appears capable of accurately predicting the occurrence of chorioamnionitis, as the diagnostic performance of tested biomarkers remains modest. Over the past five years, no new biomarker has been evaluated frequently enough to allow for a meta-analysis of its diagnostic accuracy. This emphasizes the importance of identifying new predictive biomarkers, particularly through large-scale proteomic approaches.
Puravet et al. (Thu,) studied this question.