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.