Serum surfactant protein D as a significant biomarker for predicting occurrence, progression, acute exacerbation, and mortality in interstitial lung disease: a systematic review and meta-analysis

ObjectiveSerum surfactant protein D (SP-D) is a potential biomarker for the non-invasive prediction of interstitial lung disease (ILD) status. However, previous studies lacked comprehensively qualitative and quantitative pooled analysis methods to summarize the relationship between SP-D and ILD.Meth...

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Main Authors: Xing He, Jiaqi Ji, Dan Zheng, Zeli Luo, Linjie Luo, Lu Guo
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-02-01
Series:Frontiers in Immunology
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Online Access:https://www.frontiersin.org/articles/10.3389/fimmu.2025.1450798/full
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author Xing He
Xing He
Jiaqi Ji
Dan Zheng
Zeli Luo
Linjie Luo
Lu Guo
author_facet Xing He
Xing He
Jiaqi Ji
Dan Zheng
Zeli Luo
Linjie Luo
Lu Guo
author_sort Xing He
collection DOAJ
description ObjectiveSerum surfactant protein D (SP-D) is a potential biomarker for the non-invasive prediction of interstitial lung disease (ILD) status. However, previous studies lacked comprehensively qualitative and quantitative pooled analysis methods to summarize the relationship between SP-D and ILD.MethodsWe conducted a comprehensive literature search from PubMed, Embase, Web of Science, Scopus, Ovid, and Cochrane Library, up to 16 December 2023. The Newcastle–Ottawa Quality Assessment Scale was employed to evaluate the quality of each included study. Pooled analyses were primarily performed for weighted mean difference (WMD), odds ratio (OR), and hazard ratio (HR). Sensitivity analysis was conducted by sequentially eliminating one study at a time and reanalyzing the remaining studies. In addition, the trim-and-fill method was applied for correcting publication bias.ResultsMore than 3,561 patients with ILD from 41 articles were included for pooled analysis. The pooled results showed that serum SP-D levels were higher in the ILD group than the control group (WMD = 120.24 ng/mL, 95% CI: 72.45–168.03, p<0.001). Additionally, SP-D levels among patients with ILD were significantly elevated in the acute exacerbation (AE) group compared with the non-AE group (WMD = 9.88 ng/mL, 95% CI: 2.64–17.12, p=0.008), and in the death group compared with the survival group (WMD = 32.98 ng/mL, 95% CI: 2.11–63.84, p=0.036). However, no significant difference was observed between the progression group and the stable group (WMD = 13.54 ng/mL, 95% CI: −23.68–50.76, p=0.227). In addition, pooled results demonstrated that serum SP-D was a reliable predictive factor for various outcomes associated with ILD: occurrence (OR=4.66, 95%CI = 2.46, 8.86, p<0.001), progression (OR=1.003, 95%CI= 1.001, 1.006, p=0.033), and mortality (HR=1.002, 95%CI= 1.001, 1.003, p=0.023) of ILD. In contrast, there was no significant difference for predicting AE (HR = 1.004, 95% CI = 0.997, 1.011, p=0.240).ConclusionSerum SP-D is a significant biomarker associated with ILD occurrence, progression, acute exacerbation, and mortality. It remains essential to clarify the predictive value of serum SP-D levels concerning the disease status in patients with different ILD subtypes. Moreover, it may be beneficial to conduct a combined analysis of SP-D with other potential biomarkers to further enhance its diagnostic capability regarding the disease status in patients with ILD.Systematic Review Registrationhttps://inplasy.com/inplasy-2024-5-0050/, identifier INPLASY 202450050.
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spelling doaj-art-e9da136a312543bcb019b17b5c5985102025-08-20T03:11:37ZengFrontiers Media S.A.Frontiers in Immunology1664-32242025-02-011610.3389/fimmu.2025.14507981450798Serum surfactant protein D as a significant biomarker for predicting occurrence, progression, acute exacerbation, and mortality in interstitial lung disease: a systematic review and meta-analysisXing He0Xing He1Jiaqi Ji2Dan Zheng3Zeli Luo4Linjie Luo5Lu Guo6Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, ChinaState Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaDepartment of Pulmonary and Critical Care Medicine, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, ChinaDepartment of Critical Care Medicine, Wenjiang District People’s Hospital of Chengdu, Chengdu, ChinaDepartment of Critical Care Medicine, Wenjiang District People’s Hospital of Chengdu, Chengdu, ChinaDepartment of Critical Care Medicine, Wenjiang District People’s Hospital of Chengdu, Chengdu, ChinaDepartment of Pulmonary and Critical Care Medicine, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, ChinaObjectiveSerum surfactant protein D (SP-D) is a potential biomarker for the non-invasive prediction of interstitial lung disease (ILD) status. However, previous studies lacked comprehensively qualitative and quantitative pooled analysis methods to summarize the relationship between SP-D and ILD.MethodsWe conducted a comprehensive literature search from PubMed, Embase, Web of Science, Scopus, Ovid, and Cochrane Library, up to 16 December 2023. The Newcastle–Ottawa Quality Assessment Scale was employed to evaluate the quality of each included study. Pooled analyses were primarily performed for weighted mean difference (WMD), odds ratio (OR), and hazard ratio (HR). Sensitivity analysis was conducted by sequentially eliminating one study at a time and reanalyzing the remaining studies. In addition, the trim-and-fill method was applied for correcting publication bias.ResultsMore than 3,561 patients with ILD from 41 articles were included for pooled analysis. The pooled results showed that serum SP-D levels were higher in the ILD group than the control group (WMD = 120.24 ng/mL, 95% CI: 72.45–168.03, p<0.001). Additionally, SP-D levels among patients with ILD were significantly elevated in the acute exacerbation (AE) group compared with the non-AE group (WMD = 9.88 ng/mL, 95% CI: 2.64–17.12, p=0.008), and in the death group compared with the survival group (WMD = 32.98 ng/mL, 95% CI: 2.11–63.84, p=0.036). However, no significant difference was observed between the progression group and the stable group (WMD = 13.54 ng/mL, 95% CI: −23.68–50.76, p=0.227). In addition, pooled results demonstrated that serum SP-D was a reliable predictive factor for various outcomes associated with ILD: occurrence (OR=4.66, 95%CI = 2.46, 8.86, p<0.001), progression (OR=1.003, 95%CI= 1.001, 1.006, p=0.033), and mortality (HR=1.002, 95%CI= 1.001, 1.003, p=0.023) of ILD. In contrast, there was no significant difference for predicting AE (HR = 1.004, 95% CI = 0.997, 1.011, p=0.240).ConclusionSerum SP-D is a significant biomarker associated with ILD occurrence, progression, acute exacerbation, and mortality. It remains essential to clarify the predictive value of serum SP-D levels concerning the disease status in patients with different ILD subtypes. Moreover, it may be beneficial to conduct a combined analysis of SP-D with other potential biomarkers to further enhance its diagnostic capability regarding the disease status in patients with ILD.Systematic Review Registrationhttps://inplasy.com/inplasy-2024-5-0050/, identifier INPLASY 202450050.https://www.frontiersin.org/articles/10.3389/fimmu.2025.1450798/fullsurfactant protein Dinterstitial lung diseaseoccurrenceprogressionacute exacerbationmortality
spellingShingle Xing He
Xing He
Jiaqi Ji
Dan Zheng
Zeli Luo
Linjie Luo
Lu Guo
Serum surfactant protein D as a significant biomarker for predicting occurrence, progression, acute exacerbation, and mortality in interstitial lung disease: a systematic review and meta-analysis
Frontiers in Immunology
surfactant protein D
interstitial lung disease
occurrence
progression
acute exacerbation
mortality
title Serum surfactant protein D as a significant biomarker for predicting occurrence, progression, acute exacerbation, and mortality in interstitial lung disease: a systematic review and meta-analysis
title_full Serum surfactant protein D as a significant biomarker for predicting occurrence, progression, acute exacerbation, and mortality in interstitial lung disease: a systematic review and meta-analysis
title_fullStr Serum surfactant protein D as a significant biomarker for predicting occurrence, progression, acute exacerbation, and mortality in interstitial lung disease: a systematic review and meta-analysis
title_full_unstemmed Serum surfactant protein D as a significant biomarker for predicting occurrence, progression, acute exacerbation, and mortality in interstitial lung disease: a systematic review and meta-analysis
title_short Serum surfactant protein D as a significant biomarker for predicting occurrence, progression, acute exacerbation, and mortality in interstitial lung disease: a systematic review and meta-analysis
title_sort serum surfactant protein d as a significant biomarker for predicting occurrence progression acute exacerbation and mortality in interstitial lung disease a systematic review and meta analysis
topic surfactant protein D
interstitial lung disease
occurrence
progression
acute exacerbation
mortality
url https://www.frontiersin.org/articles/10.3389/fimmu.2025.1450798/full
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