Diagnostic Meta-analysis Research Articles

320 Machine learning for the prediction of placenta accreta spectrum- systematic review and diagnostic meta analysis

320 Machine learning for the prediction of placenta accreta spectrum- systematic review and diagnostic meta analysis

Diagnostic Accuracy of Waist-to-Height Ratio, Waist Circumference, and Body Mass Index in Identifying Metabolic Syndrome and Its Components in Older Adults: A Systematic Review and Meta-Analysis

BackgroundAlthough numerous studies have indicated the utility of waist-to-height ratio (WHtR) in early screening for individuals with adverse cardiometabolic health, there is controversy on using WHtR as a one-size-fits-all approach, including in older adults. ObjectivesOur study aims to identify the pooled diagnostic accuracy of WHtR in screening for metabolic syndrome (MetS) and its components among older adults. MethodsA systematic review of observational studies was performed using 4 databases. A diagnostic meta-analysis with a random effects model was conducted, and the pooled area under the summary receiver operating characteristic curve, sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio (dOR) of each outcome compared with WHtR, body mass index (BMI), and waist circumference (WC) were calculated, with sex-stratified analysis. ResultsA total of 17 studies with 74,520 participants were included. As reflected by the dOR, WHtR (7.65; 95% CI: 6.00, 9.75) performed better than BMI (5.17; 95% CI: 4.75, 5.62) and WC (5.77; 95% CI: 4.60, 7.25) in screening for MetS among older adults and was potentially better among males. For hyperglycemia, hypertension, and dyslipidemia, the performances of WHtR, BMI, and WC were comparable. ConclusionMore studies focusing on older adults are still needed to determine the cutoff values of WHtR to screen for MetS.The search strategy was registered in PROSPERO as CRD42022350379.

Relapse in clinically stable adult patients with schizophrenia or schizoaffective disorder: evidence-based criteria derived by equipercentile linking and diagnostic test accuracy meta-analysis

There is no consensus on defining relapse in schizophrenia, and scale-derived criteria with unclear clinical relevance are widely used. We aimed to develop an evidence-based scale-derived set of criteria to define relapse in patients with schizophrenia or schizoaffective disorder. We searched the Yale University Open Data Access (YODA) for randomised controlled trials (RCTs) in clinically stable adults with schizophrenia or schizoaffective disorder, and obtained individual participant data on Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Severity (CGI-S), Personal and Social Performance (PSP), and Social and Occupational Functioning Assessment Scale (SOFAS). Our main outcomes were PANSS-derived criteria based on worsening in PANSS total score. We examined their relevance using equipercentile linking with CGI-S and functioning scales, and their test-performance in defining relapse with diagnostic test accuracy meta-analysis against CGI-S worsening (≥1-point increase together with a score ≥4 points) and psychiatric hospitalisation. Based on data from seven RCTs (2354 participants; 1348 men [57·3%] and 1006 women [42·7%], mean age of 39·5 years [SD 12·0, range 17-89]; 303 Asian [12.9%], 255 Black [10.8%], 1665 White [70.7%], and other or unspecified 131 [5.6%]), an increase of 12 points or more in PANSS total (range 30-210 points) corresponded to clinically important deterioration in global severity of illness (≥1 point increase in CGI-S, range 1-7) and functioning (≥10 points decline in PSP or SOFAS, range 1-100). The interpretation of percentage changes varied importantly across different baseline scores. An increase of 12 points or more in PANSS total had good sensitivity and specificity using CGI-S as reference standard (sensitivity 82·1% [95% CI 77·1-86·4], specificity 86·9% [82·9-90·3]), as well as good sensitivity but lower specificity compared to hospitalisation (sensitivity 81·7% [74·1-87·7], specificity 69·2% [60·5-76·9]). Requiring either an increase in PANSS total or in specific items for positive and disorganization symptoms further improved test-performance. Cutoffs for situations where high sensitivity or specificity is needed are presented. An increase of either 12 points or more in the PANSS total score, or worsening of specific positive and disorganisation symptom items could be a reasonable evidence-based definition of relapse in schizophrenia, potentially linking symptoms used to define remission and relapse. Percentage changes should not be used to define relapse because their interpretation depends on baseline scores. German Research Foundation (grant number: 428509362).

Radiomics to Differentiate Malignant and Benign Breast Lesions: A Systematic Review and Diagnostic Test Accuracy Meta-Analysis.

Breast cancer is a prevalent global health concern, necessitating accurate diagnostic tools for effective management. Diagnostic imaging plays a pivotal role in breast cancer diagnosis, staging, treatment planning, and outcome evaluation. Radiomics is an emerging field of study in medical imaging that contains a broad set of computational methods to extract quantitative features from radiographic images. This can be utilized to guide diagnosis, treatment response, and prognosis in clinical settings. A systematic review was performed in concordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. Quality was assessed using the radiomics quality score. Diagnostic sensitivity and specificity of radiomics analysis, with 95% confidence intervals (CIs), were included for meta-analysis. The area under the curve analysis was recorded. An extensive statistical analysis was performed following the Cochrane guidelines. Statistical significance was determined if p-values were less than 0.05. Statistical analyses were conducted using Review Manager (RevMan), Version 5.4.1. A total of 31 manuscripts involving 8,773 patients were included, with 17 contributing to the meta-analysis. The cohort comprised 56.2% malignant breast cancers and 43.8% benign breast lesions. MRI demonstrated a sensitivity of 0.91 (95% CI: 0.89-0.92) and a specificity of 0.84 (95% CI: 0.82-0.86) in differentiating between benign and malignant breast cancers. Mammography-based radiomic features predicted breast cancer subtype with a sensitivity of 0.79 (95% CI: 0.76-0.82) and a specificity of 0.81 (95% CI: 0.79-0.84). Ultrasound-based analysis yielded a sensitivity of 0.92 (95% CI: 0.90-0.94) and a specificity of 0.85 (95% CI: 0.83-0.88). Only one study reported the results of radiomic evaluation from CT, which had a sensitivity of 0.95 (95% CI: 0.88-0.99) and a specificity of 0.56 (95% CI: 0.45-0.67). Across different imaging modalities, radiomics exhibited robust diagnostic accuracy in differentiating benign and malignant breast lesions. The results underscore the potential of radiomic assessment as a minimally invasive alternative or adjunctive diagnostic tool for breast cancer. This is pioneering data that reports on a novel diagnostic approach that is understudied and underreported. However, due to study limitations, the complexity of this technology, and the need for future development, biopsy still remains the current gold standard method of determining breast cancer type.

A multiple cut-off diagnostic meta-analysis to identify the atrial high-rate episodes threshold that better relates to thromboembolic events

Abstract Background Despite the high prevalence of atrial high-rate episodes (AHRE) detected by cardiac implantable electronic devices (CIED), clinical guidelines and consensus documents have failed to agree on a universal AHRE definition. Clear evidence on the best management strategy is lacking. Purpose The present is a diagnostic test accuracy meta-analysis aiming to derive from available literature the optimal AHRE threshold to predict thromboembolic events. Methods PubMed/MEDLINE and EMBASE databases were screened for studies on CIED patients reporting incidence of thromboembolic events referred to at least one AHRE definition. A random-effect diagnostic test accuracy meta-analysis with multiple cut-offs was performed: duration of AHRE was the "diagnostic test" (positive test if the patients experienced an AHRE lasting at least as long as the time cut-off under examination) whose performance in predicting the "disease" (thromboembolic events) was evaluated across multiple cut-offs. Two analyses, according to AHRE definition (longest episode vs. cumulative burden), were performed. Results 23 studies were included in the analyses (Fig. 1 Panel A), encompassing 46,189 patients: 19 considering the longest single AHRE and 4 the AHRE burden, respectively. Median follow-up was 40.75 (IQR 28.25-52.80) months. The analysis on the longest single AHRE indicated 0.07 minutes as the optimal cut-off to differentiate AHRE associated or not to thromboembolic events [sensitivity 65.4% (95% CI 48.8-79.0%), specificity 52.7% (95%CI 46.0-59.4%), area under the summary receiver operating characteristic curve (AUC-SROC): 0.62; Fig. 1 Panel B]. The analysis on AHRE burden indicated, instead, 1.4 minutes as the optimal cut-off [sensitivity 58.2% (95%CI 25.6-85.0%), specificity 57.5% (95% CI 42.0-71.7%), AUC-SROC 0.60; Fig. 1 Panel C]. PPV and NPV for 6 minutes and 24 hours cut-offs were similar in each analysis (Figure 2). Sensitivity analyses exclusively considering studies reporting data on patients without previous AF diagnosis and high-quality studies only yield similar results. Conclusion The present evidence-based approach suggests the presence (or not) of AHRE, rather than a specific duration, relates to an increased thromboembolic risk in CIED patients. A linear relationship between AHRE duration (both in terms of single longest episode than cumulative burden) and thromboembolic events was not observed.

Role of atrial high-rate episodes in stratifying thromboembolic risk: a multiple cut-off diagnostic meta-analysis.

Despite the high prevalence rate of atrial high-rate episodes (AHREs) detected using cardiac implantable electronic devices (CIEDs), clinical guidelines and consensus documents have disagreed on a universal AHRE definition and a temporal cut-off related to subsequent thromboembolic events. This diagnostic test accuracy meta-analysis aims to derive the optimal temporal threshold of clinically significant AHREs from the available literature. The PubMed/MEDLINE and EMBASE databases were screened for studies on CIED patients reporting the incidence of thromboembolic events related to at least one AHRE temporal cut-off. A total of 23 studies were included: 19 considering the longest single AHRE and four the AHRE burden, respectively. A random-effect diagnostic test accuracy meta-analysis with multiple cut-offs was performed. Two analyses were performed according to the AHRE temporal cut-off subtype (longest episode vs. cumulative burden). The analysis on the longest single AHRE indicated 0.07 min as the optimal duration to differentiate AHRE associated or not with thromboembolic events [sensitivity 65.4% (95% CI 48.8%-79.0%), specificity 52.7% (95% CI 46.0%-59.4%), and area under the summary receiver operating characteristic curve (AUC-SROC): 0.62]. The analysis on AHRE burden indicated 1.4 min as the optimal cut-off [sensitivity 58.2% (95% CI 25.6%-85.0%), specificity 57.5% (95% CI 42.0%-71.7%), and AUC-SROC 0.60]. A sensitivity analysis excluding patients with a history of atrial fibrillation and including high-quality studies only yielded similar results. The presence of AHRE, rather than a specific duration, relates to an increased, albeit low, thromboembolic risk in CIED patients. Any AHRE should constitute an additional element in patient-specific thromboembolic risk assessment.

Abstract 208: Evaluating the Predictive Power of Serum Biomarkers Neuron-Specific Enolase, S-100B Protein, and Neurofilament Light Chain for Neurological Outcomes Following Cardiac Arrest: A Diagnostic Accuracy Meta-Analysis

Introduction: The assessment of serum biomarkers, specifically Neuron-Specific Enolase, S-100B protein, and Neurofilament Light Chain, at 24 hours post-cardiac arrest is under investigation for its ability to predict brain injury. Aim: This study aims to evaluate the accuracy of serum biomarkers NSE, S-100B protein, and NFL predicting post-cardiac arrest neurological outcomes. Methods: A systematic search up to December 2022 across PubMed, Embase, and Scopus identified studies examining the association between 24-hour serum levels of NSE, S-100B protein, or NFL and neurological outcomes post-cardiac arrest. Statistical analyses were conducted using R software with mada package to pool sensitivity, specificity, false-positive rates, diagnostic odds ratios, and positive and negative likelihood ratios; each expressed with a 95% Confidence Interval. Results: We incorporated 3 studies, with 759 patients in S-100B protein group, 753 in NSE group, and 799 in NFL group. At 24 hours post-cardiac arrest, NSE showed a pooled sensitivity of 37.7% (95% CI: 24.4-53.2%, I2=85.7%) and specificity of 85.5% (95% CI: 81.6-88.7%, I2=0%). S-100B protein demonstrated a pooled sensitivity of 54.7% (95% CI: 32.1-75.5%, I2=94.8%) and specificity of 81% (95% CI: 66.9-90.1%, I2=82.3%). NFL exhibited a pooled sensitivity of 88.1% (95% CI: 47.7-98.4%, I2=93.8%) and specificity of 93.6% (95% CI: 85.4-97.3%, I2=77.7%). The diagnostic odds ratios were 3.57 (95% CI: 1.79-7.15) for NSE, 5.15 (95% CI: 1.55-17.14) for S-100B protein, and 108.65 (95% CI: 11.02-1071.24) for NFL. The positive Likelihood Ratios were 2.61 (95% CI: 1.64-4.14) for NSE, 2.88 (95% CI: 1.37-6.06) for S-100B protein, and 13.87 (95% CI: 5.64-33.69) for NFL, while the negative Likelihood Ratios were 0.73 (95% CI: 0.57-0.93) for NSE, 0.19 (95% CI: 0.9-0.33) for S-100B protein, and 0.06 (95% CI: 0.03-0.15) for NFL. Conclusion: Brain biomarkers NSE, S-100B protein, and NFL, especially NFL, with its superior sensitivity and specificity, are promising in predicting neurological outcomes post-cardiac arrest, aiding clinicians in patient management and family communication. The limited number of studies and heterogeneity in results necessitate further validation and research of their predictability.

Abstract 15577: Diagnostic Performance of Cadmium-Zinc-Telluride Single-Photon Emission Computed Tomography versus Coronary Angiography Fractional Flow Reserve in Estimating Myocardial Blood Flow and Flow Reserve: A Diagnostic Accuracy Meta-Analysis

Introduction: Precisely estimating myocardial blood flow and flow reserve is crucial in diagnosing and managing ischemic heart disease. Coronary angiography fractional flow reserve (FFR) has been a standard tool. However, the recent emergence of Cadmium-Zinc-Telluride Single-Photon Emission Computed Tomography (CZT-SPECT) has provided an innovative diagnostic approach. Consequently, a comprehensive comparative analysis of their efficacies in evaluating myocardial blood flow and flow reserve is necessary. Hypothesis: This study aims to determine the diagnostic accuracy of CZT-SPECT compared to coronary angiography FFR in estimating myocardial blood flow and flow reserve. Methods: A systematic search until July 2022 was conducted across databases such as PubMed, Embase, and Web of Science, focusing on studies comparing CZT-SPECT and coronary angiography FFR in the estimation of myocardial blood flow and flow reserve. Utilizing the mada package in R software (version 4.0.3), we conducted diagnostic accuracy analysis by pooling metrics like sensitivity, specificity, false-positive rate estimates, diagnostic odds ratio, and positive and negative Likelihood Ratios (LR), all of which were presented with a 95% Confidence Interval (CI). Results: The meta-analysis incorporated 6 studies with a total patient population of 346. Our findings reveal that CZT-SPECT exhibited a pooled sensitivity of 79.1% (95% CI: 71.8-84.9%, I^2=0) and a specificity of 78.5% (95% CI: 70.4-84.8%, I^2=25.3%). The false-positive rate was 21.5% (95% CI: 15.2-29.6%). Moreover, CZT-SPECT demonstrated a diagnostic odds ratio of 13.75 (95% CI: 7.67-24.65), while the positive likelihood ratio was 3.67 (95% CI: 2.59-5.19), and the negative likelihood ratio stood at 0.26 (95% CI: 0.19-0.37). Conclusions: This study provides valuable insights into the diagnostic accuracy of CZT-SPECT compared to coronary angiography FFR in estimating myocardial blood flow and flow reserve. These findings indicate that while CZT-SPECT shows promising diagnostic potential, its performance is similar to coronary angiography FFR. The results will be instrumental in informing clinical decision-making and shaping future research directions in the field of cardiovascular imaging.

Gastric Cancer and Circulating microRNAs: An Updated Systematic Review and Diagnostic Meta-Analysis.

Circulating microRNAs (miRNAs, miRs) are now used as noninvasive diagnostic indicators in various malignancies. Our objective is to use a meta-analysis to assess the diagnostic performance of circulating miRNAs in gastric cancer. We reviewed databases and methodically obtained papers for analysis until October 15th, 2021. The random-effect meta-analysis was performed to construct pooled diagnostic parameters. To detect the causes of heterogeneity, spearman threshold effect analysis and subgroup analysis were performed. The I2 and Chi-square tests were also used to examine the heterogeneity. The subgroup analyses were conducted based on sample types (serum/plasma/blood), normalized genes (U6, miR-16, and miR-39), qPCR mastermix (SYBR and Taqman), and country. Finally, the publication bias was estimated using Egger's funnel plot asymmetry test. A total of 40 articles covering 73 studies (59 microRNAs) were included, containing 11,022 participants (6,324 cases and 4,698 controls). The overall pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) were 0.75 (95% CI: 0.74-0.77), 0.79 (95% CI: 0.78-0.80), 4.081 (95% CI: 3.43-4.85), 0.28 (95% CI: 0.25-0.32), 16.08 (95% CI: 12.34-20.95), and 0.877 (CI: 0.84-0.90), respectively. We conducted a subgroup analysis of diagnostic values, which revealed that serum type, U6 reference gene, SYBR mastermix, and East Asian Countries (China and Japan) had better diagnostic value. Circulating miRs can serve as diagnostic biomarkers for gastric cancer. However, specific miRNAs still need to be discovered in diagnosing gastric cancer, especially early screening.

A Systematic Review of Deep-Learning Methods for Intracranial Aneurysm Detection in CT Angiography.

Background: Subarachnoid hemorrhage resulting from cerebral aneurysm rupture is a significant cause of morbidity and mortality. Early identification of aneurysms on Computed Tomography Angiography (CTA), a frequently used modality for this purpose, is crucial, and artificial intelligence (AI)-based algorithms can improve the detection rate and minimize the intra- and inter-rater variability. Thus, a systematic review and meta-analysis were conducted to assess the diagnostic accuracy of deep-learning-based AI algorithms in detecting cerebral aneurysms using CTA. Methods: PubMed (MEDLINE), Embase, and the Cochrane Library were searched from January 2015 to July 2023. Eligibility criteria involved studies using fully automated and semi-automatic deep-learning algorithms for detecting cerebral aneurysms on the CTA modality. Eligible studies were assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. A diagnostic accuracy meta-analysis was conducted to estimate pooled lesion-level sensitivity, size-dependent lesion-level sensitivity, patient-level specificity, and the number of false positives per image. An enhanced FROC curve was utilized to facilitate comparisons between the studies. Results: Fifteen eligible studies were assessed. The findings indicated that the methods exhibited high pooled sensitivity (0.87, 95% confidence interval: 0.835 to 0.91) in detecting intracranial aneurysms at the lesion level. Patient-level sensitivity was not reported due to the lack of a unified patient-level sensitivity definition. Only five studies involved a control group (healthy subjects), whereas two provided information on detection specificity. Moreover, the analysis of size-dependent sensitivity reported in eight studies revealed that the average sensitivity for small aneurysms (<3 mm) was rather low (0.56). Conclusions: The studies included in the analysis exhibited a high level of accuracy in detecting intracranial aneurysms larger than 3 mm in size. Nonetheless, there is a notable gap that necessitates increased attention and research focus on the detection of smaller aneurysms, the use of a common test dataset, and an evaluation of a consistent set of performance metrics.

Test Characteristics of Emergency Medicine-Performed Point-of-Care Ultrasound for the Diagnosis of Acute Cholecystitis: A Systematic Review and Meta-analysis

Acute cholecystitis accounts for up to 9% of hospital admissions for acute abdominal pain, and best practice entails early surgical management. Ultrasound is the standard modality used to confirm diagnosis. Our objective was to perform a systematic review and meta-analysis to determine the diagnostic accuracy of emergency physician-performed point-of-care ultrasound for the diagnosis of acute cholecystitis when compared with a reference standard of final diagnosis (informed by available surgical pathology, discharge diagnosis, and radiology-performed ultrasound). We completed a systematic review and meta-analysis, registered in PROSPERO, in adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched 7 databases as well as gray literature in the form of select conference abstracts from inception to February 8, 2023. Two independent reviewers completed study selection, data extraction, and risk of bias (QUADAS-2) assessment. Disagreements were resolved by consensus with a third reviewer. Data were extracted from eligible studies to create 2× 2 tables for diagnostic accuracy meta-analysis. Hierarchical Summary Receiver Operating Characteristic models were constructed. Of 1855 titles/abstracts, 40 were selected for full-text review. Ten studies (n=2356) were included. Emergency physician-performed point-of-care ultrasound with final diagnosis as the reference standard (7 studies, n=1,772) had a pooled sensitivity of 70.9% (95% confidence interval [CI] 62.3 to 78.2), specificity of 94.4% (95% CI 88.2 to 97.5), positive likelihood ratio of 12.7 (5.8 to 27.5), and negative likelihood ratio of 0.31 (0.23 to 0.41) for the diagnosis of acute cholecystitis. Emergency physician-performed point-of-care ultrasound has high specificity and moderate sensitivity for the diagnosis of acute cholecystitis in patients with clinical suspicion. This review supports the use of emergency physician-performed point-of-care ultrasound to rule in a diagnosis of acute cholecystitis in the emergency department, which may help expedite definitive management.

S611 Diagnostic Accuracy of Artificial Intelligence in the Diagnosis of Intestinal Metaplasia and Dysplasia in Patients With Barrett’s Esophagus: A Diagnostic Test Accuracy Meta-Analysis

S611 Diagnostic Accuracy of Artificial Intelligence in the Diagnosis of Intestinal Metaplasia and Dysplasia in Patients With Barrett’s Esophagus: A Diagnostic Test Accuracy Meta-Analysis

83P Evaluation of serum macrophage inhibitory cytokine 1 as a diagnostic biomarker for pancreatic cancer: A systematic review and diagnostic accuracy meta-analysis

83P Evaluation of serum macrophage inhibitory cytokine 1 as a diagnostic biomarker for pancreatic cancer: A systematic review and diagnostic accuracy meta-analysis

S1897 Comparing Artificial Intelligence-Assisted and Clinician-Performed Endoscopy in the Diagnosis of Chronic Atrophic Gastritis: A Diagnostic Accuracy Meta-Analysis

S1897 Comparing Artificial Intelligence-Assisted and Clinician-Performed Endoscopy in the Diagnosis of Chronic Atrophic Gastritis: A Diagnostic Accuracy Meta-Analysis

MicroRNAs in Parkinson’s disease: a systematic review and diagnostic accuracy meta-analysis

Current clinical tests for Parkinson’s disease (PD) provide insufficient diagnostic accuracy leading to an urgent need for improved diagnostic biomarkers. As microRNAs (miRNAs) are promising biomarkers of various diseases, including PD, this systematic review and meta-analysis aimed to assess the diagnostic accuracy of biofluid miRNAs in PD. All studies reporting data on miRNAs expression in PD patients compared to controls were included. Gene targets and significant pathways associated with miRNAs expressed in more than 3 biofluid studies with the same direction of change were analyzed using target prediction and enrichment analysis. A bivariate model was used to calculate sensitivity, specificity, likelihood ratios, and diagnostic odds ratio. While miR-24-3p and miR-214-3p were the most reported miRNA (7 each), miR-331-5p was found to be consistently up regulated in 4 different biofluids. Importantly, miR-19b-3p, miR-24-3p, miR-146a-5p, and miR-221-3p were reported in multiple studies without conflicting directions of change in serum and bioinformatic analysis found the targets of these miRNAs to be associated with pathways important in PD pathology. Of the 102 studies from the systematic review, 15 studies reported sensitivity and specificity data on combinations of miRNAs and were pooled for meta-analysis. Studies (17) reporting sensitivity and specificity data on single microRNA were pooled in a separate meta-analysis. Meta-analysis of the combinations of miRNAs (15 studies) showed that biofluid miRNAs can discriminate between PD patients and controls with good diagnostic accuracy (sensitivity = 0.82, 95% CI 0.76–0.87; specificity = 0.80, 95% CI 0.74–0.84; AUC = 0.87, 95% CI 0.83–0.89). However, we found multiple studies included more males with PD than any other group therefore possibly introducing a sex-related selection bias. Overall, our study captures key miRNAs which may represent a point of focus for future studies and the development of diagnostic panels whilst also highlighting the importance of appropriate study design to develop representative biomarker panels for the diagnosis of PD.

Diagnostic evaluation of Panbio™ antigen rapid diagnostic test for SARS‐CoV‐2: A systematic review and meta-analysis

IntroductionThe reverse transcriptase polymerase chain reaction (RT-PCR) is the reference diagnostic method for the confirmation of SARS-CoV-2 infected cases. However, various antigen rapid diagnostic tests (Ag-RDTs) have been developed. The purpose of this meta-analysis study was to assess the diagnostic performance of Panbio™ Ag-RDT (Abbott Point of Care) in identifying the SARS-CoV-2 virus. MethodsWe systematically searched eight databases from March 2020 until March 2023 to look for potentially eligible articles. Diagnostic meta-analysis of Panbio™ Ag-RDT used diverse evaluation indicators, including sensitivity, specificity, Diagnostic Odds Ratio (DOR), and the area under the curve (AUC) value. ResultsOf the 794 articles identified, 49 studies met the inclusion criteria. The pooled estimates of Panbio™ Ag-RDT for the diagnosis of SARS-CoV-2 were 0,65 (95% CI: 0,64–0,66), 0,99 (95% CI: 0,99–1,00), 578,03 (95% CI: 333,37–1002,26) for sensitivity, specificity, and DOR, respectively. Moreover, the summary receiver operating characteristic (SROC) curve revealed an AUC value of 0,942 (95% CI: 0,941–0,943), suggesting an outstanding diagnostic accuracy. Subgroup and meta-regression analyses showed that continent, study period, age, study population and cycle threshold (Ct) values constituted a source of heterogeneity. Furthermore, we demonstrated proof of publication bias for DOR values analyzed using Deek’s test (p = 0,001) and funnel plot. ConclusionPanbio™ Ag-RDT presented an outstanding diagnostic accuracy in the detection of the SARS-CoV-2 virus in both adults and children with or without symptoms.

Multi-Level Biomarkers for Early Diagnosis of Ischaemic Stroke: A Systematic Review and Meta-Analysis.

Blood biomarkers hold potential for the early diagnosis of ischaemic stroke (IS). We aimed to evaluate the current weight of evidence and identify potential biomarkers and biological pathways for further investigation. We searched PubMed, EMBASE, the Cochrane Library and Web of Science, used R package meta4diag for diagnostic meta-analysis and applied Gene Ontology (GO) analysis to identify vital biological processes (BPs). Among 8544 studies, we included 182 articles with a total of 30,446 participants: 15675 IS, 2317 haemorrhagic stroke (HS), 1798 stroke mimics, 846 transient ischaemic attack and 9810 control subjects. There were 518 pooled biomarkers including 203 proteins, 114 genes, 108 metabolites and 88 transcripts. Our study generated two shortlists of biomarkers for future research: one with optimal diagnostic performance and another with low selection bias. Glial fibrillary acidic protein was eligible for diagnostic meta-analysis, with summary sensitivities and specificities for differentiating HS from IS between 3 h and 24 h after stroke onset ranging from 73% to 80% and 77% to 97%, respectively. GO analysis revealed the top five BPs associated with IS. This study provides a holistic view of early diagnostic biomarkers in IS. Two shortlists of biomarkers and five BPs warrant future investigation.

Distance from skin to epiglottis measurement with ultrasonography as a predictor of difficult laryngoscopy: A diagnostic test accuracy meta-analysis

BackgroundThe studies investigating distance from the skin to epiglottis measurements by ultrasonography (US-DSEM) for prediction of difficult laryngoscopy are inconclusive and non-standardised. AimWe aimed to assess the diagnostic test accuracy (DTA) of US-DSEM relative to Cormack Lehane 3–4 for diagnosing difficult laryngoscopy using a meta-analysis method. MethodStrict inclusion criteria were used to provide clear definition of how to measure US-DSEM. PubMed, Cochrane Library, Embase and Google Scholar were searched for papers published between January 2005 and March 2021 to perform a systematic review and DTA meta-analysis. Publications reporting data on US-DSEM in difficult laryngoscopy prediction in adults with normal airway were included. Exclusions were obese or pregnant patients and patients with difficult airway predictors and those in which the measurements were made in a position other than supine and neutral positions. The pooled sensitivity, specificity, positive/negative likelihood ratios (PLR/NLR), diagnostic odds ratio (DOR), and area under the hierarchic summary receiver operating characteristics curve (AU-HSROC) were determined. Results1244 patients from nine studies were included. Pooled sensitivity: 0.68 (95%CI 0.39–0.87), specificity: 0.76 (95%CI 0.68–0.83), PLR: 2.87 (95%CI 2.20–3.73), NLR: 0.42 (%95CI 0.20–0.87), DOR: 6.80 (95%CI 2.72–17.3), and AU-HSROC: 0.79 (0.75–0.82) were the results. No threshold effect (r = 0.53, p = 0.137) and publication bias (p = 0.540) existed. ConclusionThis meta-analysis showed that US-DSEM measured with linear probe placed transversely at the thyrohyoid membrane level with midline approach and neutral head position is accurate and has diagnostic value in predicting difficult laryngoscopy. However, its sensitivity and specificity are not sufficient to replace clinical tests.

Assessing the Efficacy of Inferior Vena Cava Collapsibility Index for Predicting Hypotension after Central Neuraxial Block: A Systematic Review and Meta-Analysis.

The use of ultrasonography to predict spinal-induced hypotension (SIH) has gained significant attention. This diagnostic meta-analysis aimed to investigate the reliability of the inferior vena cava collapsibility index (IVCCI) in predicting SIH in patients undergoing various surgeries. Databases, including Embase, Cochrane Library, Medline, and Google Scholar, were screened until 28 July 2023, yielding 12 studies with 1076 patients (age range: 25.6-79 years) undergoing cesarean section (CS) (n = 4) or non-CS surgeries (n = 8). Patients with SIH had a significantly higher IVCCI than those without SIH (mean difference: 11.12%, 95% confidence interval (CI): 7.83-14.41). The pooled incidence rate of SIH was 40.5%. IVCCI demonstrated satisfactory overall diagnostic reliability (sensitivity, 77%; specificity, 82%). The pooled area under the curve (AUC) was 0.85, indicating its high capability to differentiate patients at risk of PSH. The Fagan nomogram plot demonstrated a positive likelihood ratio (PLR) of 4 and a negative likelihood ratio (NLR) of 0.28. The results underscore the robustness and discriminative ability of IVCCI as a predictive tool for SIH. Nevertheless, future investigations should focus on assessing its applicability to high-risk patients and exploring the potential enhancement in patient safety through its incorporation into clinical practice.

Efficacy of Eustachian Tube Function Tests in Predicting Myringoplasty Success Rate

Abstract Background Tympanoplasty is a commonly performed surgical procedure to close perforations of the tympanic membrane. The results of tympanic membrane based on multiple factors as the eustachian tube dysfunction. Aim of the Work to assess the efficacy of the eustachian tube function test in predicting myringoplasty success rate and compare the efficacy of different tests in prediction of myringoplasty outcome. Material and Methods An electronic search via PubMed, Cochrane library, google scholar and web of science (WOS) until janurary2021.We included articles published in English language and conducts adult cases only. We excluded studies based on expert opinion and laboratory studies. Outcomes of interest were success rate of tympanoplasty according to eustachian tube function test and the efficacy of the different tests of eustachian tube function. Analysis was conducted using Comprehensive Meta Analysis© version 3 (Biostat© Englewood, NJ) and the jamovi project (2021); jamovi (Version 1.6.23.0) [Computer Software] for the efficacy of the eustachian tube function tests in predicting tympanoplasty success rate and using Review Manager (RevMan) [Computer program]. Version 5.4. The Cochrane Collaboration, 2020, and MetaDTA: Diagnostic Test Accuracy Meta-Analysis v2.01, 2021 for detecting and comparing the accuracy of different eustachian tube function tests. Results Regarding tympanoplasty success rate meta-analysis of the revelent 14 studies shows that preoperative normal Eustachian tube function is associated with significantly higher probability of successful graft taking (Log odds ratio = 1.78, 95% CI = 1.10 to 2.46).Regarding to the different accuracy of eustachian tube function test meta-analysis of the revelent 14 studies shows that accuracy of the tests are ranked as follows: methylene blue (most accurate), saccharine, impedance audiometry, tubomanometry and sonotubometry (least accurate). Further studies are needed to validate our findings. Conclusions Our pooled estimate suggest a good benefits of preoperative eustachian tube function test and tympanoplasty success rate. According to efficacy of different test of tympanoplasty our pooled estimate that methylene blue test is the most accurate test while the sonotubometry test is the least accurate test.However, our evidence have several limitations and there is controversy among these studies. We suggest further studies are needed to validate our findings to detect the most accurate test of eustachian tube function.