Abstract
BackgroundBronchoalveolar lavage (BAL) galactomannan (GM) assay has been used for diagnosing invasive aspergillosis (IA). We aimed to derive a definitive estimate of the overall accuracy of BAL-GM for diagnosing IA.Methods and ResultsWe undertook a systematic review of thirty diagnostic studies that evaluated the BAL-GM assay for diagnosing IA. PubMed and CBM (China Biological Medicine Database) databasees were searched for relevant studies published in all languages up until Feb 2012. The pooled diagnostic odds ratio (DOR) and summary receiver operating characteristic (SROC) were constructed for each cutoff value. Additionally, pooled sensitivity (SEN), specificity (SPE), and positive and negative likelihood ratios (PLR and NLR, respectively) were calculated for summarizing overall test performance. Thirty studies were included in this meta-analysis. The summary estimates of pooled DOR, SEN, SPE, PLR, and NLR of the BAL-GM assay (cutoff value 0.5) for proven or probable IA were 52.7 (95% confidence interval (CI) 31.8–87.3), 0.87 (95% CI 0.79–0.92), 0.89 (95% CI 0.85–0.92), 8.0 (95% CI 5.7–11.1) and 0.15 (95% CI 0.10–0.23) respectively. The SROC was 0.94 (95% CI 0.92–0.96). Compared with cutoff value of 0.5, it has higher DOR, SPE and PLR, and similar SEN and NLR with cutoff value of 1.0, which indicated the optimal cutoff value might be 1.0. Compared with BAL-GM, serum GM has a lower SEN and higher SPE, while PCR displays a lower SEN and a similar SPE.ConclusionWith the optimal cutoff value of 1.0, the BAL-GM assay has higher SEN compared to PCR and serum GM test. It is a useful adjunct in the diagnosis of proven and probable IA.
Highlights
Invasive aspergillosis (IA) is a potentially lethal infection, caused by Aspergillus fumigatus as well as other Aspergillus species which are widely distributed in soil and other organic matter[1,2]
A recent meta-analysis evaluated the quality of thirteen clinical studies that used the of Bronchoalveolar lavage (BAL)-GM test for diagnosing invasive aspergillosis (IA) among patients, and concluded that, the BAL-GM test can be used as a major diagnostic method with excellent accuracy, the BAL-GM test is not absolutely sensitive and specific[12]
This study firstly performed comparison of serum GM and BAL-GM test by meta-analysis, and the results showed that, for proven and probable IA, the pooled SEN and SPE of serum GM were 0.65 and 0.95 respectively
Summary
Invasive aspergillosis (IA) is a potentially lethal infection, caused by Aspergillus fumigatus as well as other Aspergillus species which are widely distributed in soil and other organic matter[1,2]. The rates of morbidity and mortality associated with IA infections are increasing as more and more number of patients undergo organ transplantation or allogeneic haematopoietic stem cell, and are treated with immunosuppressive agents [3,4,5]. Antifungal drugs, such as posaconazole, voriconazole, itraconazole and echinocandins, have greatly improved the therapeutic option for the treatment of IA[6]. Our research team performed a more systematic review of these and more recent clinical studies by meta-analysis to assess the accuracy of BALGM test method for diagnosing IA. We aimed to derive a definitive estimate of the overall accuracy of BAL-GM for diagnosing IA
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