Diagnosis of Invasive Fungal Disease Using Serum (1→3)-β-D-Glucan: A Bivariate Meta-Analysis

被引:74
作者
Lu, Yuan [1 ]
Chen, Yi-Qiang [2 ]
Guo, Ya-Ling [3 ]
Qin, Shou-Ming [2 ]
Wu, Cong [2 ]
Wang, Ke [2 ]
机构
[1] Guangxi Med Univ, Sch Int Educ, Nanning, Peoples R China
[2] Guangxi Med Univ, Affiliated Hosp 1, Dept Resp Dis, Nanning, Peoples R China
[3] Guangxi Med Univ, Sch Nursing, Dept Resp Dis, Nanning, Peoples R China
关键词
invasive fungal disease; beta-D-Glucan; diagnosis; BETA-D-GLUCAN; SYSTEMATIC REVIEWS; PULMONARY ASPERGILLOSIS; TRANSPLANT RECIPIENTS; NEUTROPENIC PATIENTS; INFECTIONS; ASSAY; GALACTOMANNAN; HETEROGENEITY; SURVEILLANCE;
D O I
10.2169/internalmedicine.50.6175
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background The (1 -> 3)-beta-D-Glucan (BG) assay has been approved for diagnosing invasive fungal disease (IFD). However, the test performance has been variable. We conducted a meta-analysis to determine the overall accuracy of BG assay for diagnosing IFD. Methods The sensitivity, specificity, and positive and negative likelihood ratios (PLR and NLR, respectively) of BG for diagnosing IFD were pooled using a bivariate meta-analysis. We also performed subgroup analyses. Results Twelve reports, including 15 studies, were included for the analysis (proven and probable IFD vs possible or no IFD). The sensitivity, specificity, PLR and NLR were 0.76 (95% CI, 0.67-0.83), 0.85 (95% CI, 0.73-0.92), 5.05 (95% CI, 2.71-9.43), and 0.28 (95% CI, 0.20-0.39), respectively. Subgroup analyses showed that the BG assay had higher specificities for patients with hematological disorders and a positive BG result with two consecutive samples. The combination of galactomannan and BG increased the specificity value to 0.98 (95% CI, 0.95-0.99) for diagnosing invasive aspergillosis. Conclusion Serum BG determination is clinically useful for diagnosing IFD in at-risk patients, especially for hematology patients. The combination of galactomannan and BG was sufficient for diagnosing invasive aspergillosis. Since the BG assay is not absolutely sensitive and specific for IFD, the BG results should be interpreted in parallel with clinical findings.
引用
收藏
页码:2783 / 2791
页数:9
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