Angiopoietin-2 as a prognostic biomarker in septic adult patients: a systemic review and meta-analysis

Background: The impairment of endothelial function represents a key pathophysiological mechanism in the development of sepsis. This research aimed to evaluate the prognostic significance of angiopoietin-2 (Ang-2), an endothelial biomarker, in predicting mortality in sepsis patients.

Methods: Chinese and English studies were systematically retrieved in PubMed, Cochrane Library, Embase, WanFang, CNKI, CQVIP, and CBM databases up to July 16, 2023. We conducted a study selection established upon predefined inclusion and exclusion criteria and used the Newcastle-Ottawa scale (NOS) to assess its quality. We extracted available data from the included studies for data analysis.

Results: The final inclusion comprised 33 studies with 4703 participants. According to the NOS, one study was of medium quality, while the rest were of high quality. In comparison to survivors, the levels of Ang-2 in non-survivors were markedly elevated [standardized mean difference (SMD) = 1.08, 95% confidence intervals (CI) 0.68-1.49, P < 0.001], and the same results were also observed in the subgroup that met sepsis 3.0 diagnosis criteria (SMD = 0.63, 95% CI 0.11-1.14, P = 0.017). The results comparing Ang-2 levels between non-survivors and survivors were independent of duration of follow-up, sample sources, type of study, and region. Ang-2 was a risk factor for mortality [odds ratios (OR) = 1.16, 95% CI 1.09-1.23, P < 0.001]. Ang-2 was demonstrated to be able to predict mortality in septic adult patients [area under the curve (AUC) = 0.76, 95% CI 0.70-0.82, P < 0.001].

Conclusions: Ang-2 level was positively correlated with risk of death in sepsis patients. Ang-2 might be a useful and valuable biomarker for predicting mortality in septic adult patients.