Discussion
The present meta-analysis showed increased susceptibility among the
population carrying TNF2 compared to the TNF1 allele. Teuffel et al. and
Zhang et al. also reported an increased sepsis risk among GG or AA
genotypes25,26. The inconsistency in previous studies’
results does not give a direction to this biomarker’s role. This study
revealed an association between polymorphism and sepsis among
Asian/Caucasian ethnic backgrounds. This result could help in further
conduct of prospective research among the said ethnic background.
The meta-analysis used the definition of sepsis and considered different
clinical conditions like sepsis, septicemia, septic shock for analysis.
There was no difference found in the analysis because of the different
conditions. Similarly, there was an inconsistent methodologic
description in the studies considered. However, the meta-analysis helped
in overcoming the shortcomings of the individual studies and produced a
combined effect on TNF alpha’s role during sepsis.
The study has few limitations, like fewer studies that have a larger
sample size, thus affecting the statistical power. There was high
heterogeneity among the different ethnic backgrounds, and lastly, there
is a strong need for more studies to determine the clarification on
genetic roles and cytokine production during sepsis.
The meta-analysis suggests an association between the G/A allele
combination of TNF-α and sepsis risk in the Asian population
compared to the Caucasian Population. It is also in line with Teufel et
al. and Zhang et al. Furthermore, the present meta-analysis identifies
the opportunity to get a more stratified focussed analysis by
considering similar studies in each stratum. Meta-Regression can also be
carried out to examine the hidden factors affecting the phenomenon.
Suggestive publication bias as no or fewer studies were focusing on TNF2
and sepsis’s negative analysis.
Acknowledgment: None Declared.
Statement of Ethics: All procedures performed in the study were in
accordance with the institutional and/or national research committee’s
standards and with the 1964 Helsinki declaration and its later
amendments or comparable ethical standards.
Conflict of Interest Statement: The authors declare that they have no
competing interests.
Funding Sources: No Funding was received.
Author Contributions: HN and FL: Concept and designed the study, HM and
LX: analyzed data and drafting of the manuscript; JC: Collected the data
and helped in data analysis; MH: Proofreading and final editing along
with guarantor of the manuscript. All authors read and approved the
final version of the manuscript.