Biomarkers for pneumonia after major trauma: A systematic review and meta-analysis

Background: Major trauma is a significant global health issue. Pneumonia poses an additional risk for morbidity and mortality after major trauma yet identifying pneumonia remains challenging in clinical practice. This systematic review aims to evaluate blood-based biomarkers for pneumonia in major trauma patients. Methods: The search was performed across four databases up to November 18th 2024, including primary studies investigating blood-based biomarkers associated with pneumonia in adults hospitalised after major trauma (PROSPERO CRD42024542059). Risk of bias was assessed using the ROBINS-E tool and meta-analysis was performed of pooled data. Results: Among 20 included studies, with a total of 4316 participants, the pooled mean pneumonia rate was 32.7% (23.5%–43.4%). Seventy biomarkers for post-operative pneumonia were identified, with meta-analysis possible for 12 of the reported biomarkers. At admission interleukin (IL)-6 (standardised mean difference: 1.41 (0.04–2.77), p = 0.04), cytokeratin fragment 21-1 (CYFRA21-1; 0.53 (0.19–0.86), p = 0.002) and leucocyte count (0.28 (0.05–0.50), p = 0.01) were higher in patients who developed pneumonia. During hospitalisation, patients with pneumonia had significantly higher IL-10 (4.42 (3.89–4.95), p > 0.001) and neutrophil oxidative burst capacity (1.52 (0.96–2.09), p > 0.001) at day 1, CYFRA21-1 at day 2 (0.43 (0.10–0.76), p = 0.01), IL-6 at day 3 (3.11 (2.66–3.55), p > 0.001) and day 5 (0.57 (0.05–1.09), p = 0.03) and CRP at day 4 (1.87 (1.51–2.24), p > 0.001), day 5 (1.38 (1.03–1.72), p > 0.001), day 6 (0.74 (0.42–1.06), p > 0.001) and day 7 (0.87 (0.12–1.63), p = 0.02). Across the included studies, 85% exhibited some concerns to very high risk of bias. Conclusions: While we identified potential candidate biomarkers for pneumonia in major trauma patients, the high heterogeneity across trauma populations, clinical diagnostic tools and biomarker testing methods warrants further high-quality studies to confirm their clinical value.

Citation

Howroyd, F., Sardelli, A.V., Smith, F.G., Veenith, T., Duggal, N.A., Ahmed, Z. (2026) Biomarkers for pneumonia after major trauma: A systematic review and meta-analysis. Journal of the Intensive Care Society, 27(1), pp. 66-81.

PubMed ID

40520925 (pubmed)

Additional Links

https://doi.org/10.1177/17511437251344068

Type

Journal article

Language

en

Description

© 2025 The Intensive Care Society 2025. Published by SAGE. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1177/17511437251344068

ISSN

1751-1437

EISSN

2057-360X

Collections

Faculty of Science and Engineering