Hierarchical Summary Receiver Operating Characteristic Curve Research Articles

Transient elastography for significant fibrosis in treatment-naïve CHB patients: A systematic review and meta-analysis.

Accurate diagnosis of significant liver fibrosis in patients with chronic hepatitis B (CHB) is crucial when determining whether to initiate antiviral treatment (AVT). We conduct a meta-analysis to assess the diagnostic performance of transient elastography (TE) for significant liver fibrosis in AVT-naïve CHB patients with serum alanine transaminase (ALT) levels within 5-fold the upper limit of normal (ULN). The Ovid-Medline, EMBASE, Cochrane, and KoreaMed databases were searched to identify studies that compared the performance of TE and liver biopsy (reference standard) when diagnosing significant liver fibrosis (≥ F2) in AVT-naïve CHB patients with ALT within 5-fold the ULN. A hierarchical summary receiver operating characteristic curve (HSROC) and bivariate model were performed to evaluate the diagnostic performance of TE in the meta-analysis. Eight studies (2,003 patients) were included. The summary sensitivity and specificity for diagnosis of significant liver fibrosis were 0.78 [95% confidence interval (CI), 0.66-0.86] and 0.72 (95% CI, 0.60-0.82), respectively. The HSROC for the diagnosis of significant liver fibrosis was 0.81 (95% CI, 0.72-0.86). The optimal cut-off value of TE for diagnosis of significant liver fibrosis was 7.7 kPa with a sensitivity of 0.64 (95% CI, 0.50-0.76) and specificity of 0.83 (95% CI, 0.72-0.90). Our study demonstrated that TE has an acceptable diagnostic performance for significant liver fibrosis in AVT-naïve CHB patients with ALT within 5-fold the ULN.

Diagnostic Accuracy of Transthoracic Echocardiography for Acute Type A Aortic Syndrome: A Systematic Review and Meta-Analysis

Transthoracic echocardiography (TTE) is currently recognized as the potential first-line imaging test for patients with suspected acute type A aortic syndrome (AAAS). Direct TTE sign for detecting AAAS is positive if there is an intimal flap separating two aortic lumens or aortic wall thickening seen in the ascending aorta. Indirect TTE sign indicates high-risk features of AAAS, such as aortic root dilatation, pericardial effusion, and aortic regurgitation. Our aim is to summarize the existing clinical evidence regarding the diagnostic accuracy of TTE and to evaluate its potential role in the management of patients with suspected AAAS. We included prospective or retrospective diagnostic cohort studies, written in any language, that specifically focused on using TTE to diagnose AAAS from databases such as PubMed, EMBASE, MEDLINE, and the Cochrane Library. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio [1], and hierarchical summary receiver-operating characteristic (HSROC) curve were calculated for TTE in diagnosing AAAS. We applied Quality Assessment of Diagnostic Accuracy (QUADAS-2) tool and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) quality assessment criteria. Ten studies (2886 patients) were included in the meta-analysis. The pooled sensitivity and specificity of direct TTE signs were 58% (95% CI, 38-76%) and 94% (95% CI, 89-97%). For any TTE signs, the pooled sensitivity and specificity were 91% (95% CI, 85-94%) and 74% (95% CI, 61-84%). The diagnostic accuracy of direct TTE signs was significantly higher than that of any TTE signs, as measured by the area under the HSROC curve [0.95 (95% CI, 0.92-0.96) vs. 0.87 (95% CI, 0.84-0.90)] in four studies. Our study suggests that TTE could serve as the initial imaging test for patients with suspected AAAS. Given its high specificity, the presence of direct TTE signs may indicate AAAS, whereas the absence of any TTE signs, combined with low clinical suspicion, could suggest a lower likelihood of AAAS.

MRI-based radiomics for prediction of extraprostatic extension of prostate cancer: a systematic review and meta-analysis.

We to systematically evaluate the diagnostic performance of MRI radiomics in detecting extracapsular extension (EPE) of prostate cancer (PCa). A literature search of online databases of PubMed, EMBASE, Cochrane Library, Web of Science, and Google Scholar online scientific publication databases was performed to identify studies published up to July 2023. The summary estimates were pooled with the hierarchical summary receiver-operating characteristic (HSROC) model. This study was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement, the quality of included studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool (QUADAS-2) and the radiomics quality score (RQS). Meta-regression and subgroup analyses were performed to explore the impact of varying clinical settings. A total of ten studies met the inclusion criteria. The pooled sensitivity and specificity were 0.77 (95% CI 0.68-0.84, I2 = 83.5%) and 0.75 (95% CI 0.67-0.82, I2 = 83.5%), respectively, with an area under the HSROC curve of 0.88 (95% CI 0.85-0.91). Study quality was not high while assessing with the RQS. Substantial heterogeneity was observed between studies; however, meta-regression analysis did not reveal any significant contributing factors. MRI radiomics demonstrated moderate sensitivity and specificity, offering similar diagnostic performance with previous risk stratifications and models that primarily based on radiologists' subjective experience. However, all studies included were retrospective, thus the performance of radiomics needs to validate in prospective, multicenter studies.

Hierarchical Capability in Distinguishing Severities of Sepsis via Serum Lactate: A Network Meta-Analysis.

Background: Blood lactate is a potentially useful biomarker to predict the mortality and severity of sepsis. The purpose of this study is to systematically review the ability of lactate to predict hierarchical sepsis clinical outcomes and distinguish sepsis, severe sepsis and septic shock. Methods: We conducted an exhaustive search of the PubMed, Embase and Cochrane Library databases for studies published before 1 October 2022. Inclusion criteria mandated the presence of case-control, cohort studies and randomized controlled trials that established the association between before-treatment blood lactate levels and the mortality of individuals with sepsis, severe sepsis or septic shock. Data was analyzed using STATA Version 16.0. Results: A total of 127 studies, encompassing 107,445 patients, were ultimately incorporated into our analysis. Meta-analysis of blood lactate levels at varying thresholds revealed a statistically significant elevation in blood lactate levels predicting mortality (OR = 1.57, 95% CI 1.48-1.65, I2 = 92.8%, p < 0.00001). Blood lactate levels were significantly higher in non-survivors compared to survivors in sepsis patients (SMD = 0.77, 95% CI 0.74-0.79, I2 = 83.7%, p = 0.000). The prognostic utility of blood lactate in sepsis mortality was validated through hierarchical summary receiver operating characteristic curve (HSROC) analysis, yielding an area under the curve (AUC) of 0.72 (95% CI 0.68-0.76), accompanied by a summary sensitivity of 0.65 (95% CI 0.59-0.7) and a summary specificity of 0.7 (95% CI 0.64-0.75). Unfortunately, the network meta-analysis could not identify any significant differences in average blood lactate values' assessments among sepsis, severe sepsis and septic shock patients. Conclusions: This meta-analysis demonstrated that high-level blood lactate was associated with a higher risk of sepsis mortality. Lactate has a relatively accurate predictive ability for the mortality risk of sepsis. However, the network analysis found that the levels of blood lactate were not effective in distinguishing between patients with sepsis, severe sepsis and septic shock.

Performance of trauma scoring systems in predicting mortality in geriatric trauma patients: comparison of the ISS, TRISS, and GTOS based on a systemic review and meta-analysis.

This meta-analysis aimed to evaluate the performance of the Injury Severity Score (ISS), Trauma and Injury Severity Score (TRISS), and the Geriatric Trauma Outcome Score (GTOS) in predicting mortality in geriatric trauma patients. The MEDLINE, Web of Science, and EMBASE databases were searched for studies published from January 2008 to October 2023. Studies assessing the performance of the ISS, TRISS, or GTOS in predicting mortality in geriatric trauma patients (over 60years old) and reporting data for the analysis of the pooled area under the receiver operating characteristic curve (AUROC) and the hierarchical summary receiver operating characteristic curve (HSROC) were included. Studies that were not conducted in a group of geriatric patients, did not consider mortality as the outcome variable, or had incomplete data were excluded. The Critical Appraisal Skills Programme (CASP) Clinical Prediction Rule Checklist was utilized to assess the risk of bias in included studies. STATA 16.0. was used for the AUROC analysis and HSROC analysis. Nineteen studies involving 118,761 geriatric trauma patients were included. The pooled AUROC of the TRISS (AUC = 0.82, 95% CI: 0.77-0.87) was higher than ISS (AUC = 0.74, 95% CI: 0.71-0.79) and GTOS (AUC = 0.80, 95%CI: 0.77-0.83). The diagnostic odds ratio (DOR) calculated from HSROC curves also suggested that the TRISS (DOR = 21.5) had a better performance in predicting mortality in geriatric trauma patients than the ISS (DOR = 6.27) and GTOS (DOR = 4.76). This meta-analysis suggested that the TRISS showed better accuracy and performance in predicting mortality in geriatric trauma patients than the ISS and GTOS.

Systemic immune-inflammation index for predicting postoperative atrial fibrillation following cardiac surgery: a meta-analysis.

Postoperative atrial fibrillation (POAF) is a frequent complication that may increase morbidity and mortality risk following cardiac surgery. The systemic immune-inflammation index (SII) is an emerging biomarker that provides an integrated measure of inflammation by incorporating neutrophil, lymphocyte, and platelet counts. Recent studies have reported associations between elevated SII and increased POAF risk; however, significant heterogeneity exists regarding its predictive efficacy. This meta-analysis aimed to assess SII's diagnostic efficacy for predicting POAF risk. To synthesize existing evidence on the ability of perioperative SII for predicting POAF in patients undergoing cardiac surgery, a systematic review and meta-analysis was conducted. In August 2023, a comprehensive literature search was performed to identify relevant studies reporting SII cutoff values with corresponding sensitivity and specificity. The primary aim was to evaluate SII's diagnostic utility for predicting POAF, whereas secondary outcomes included the pooled incidence of POAF and the relationship between the SII and POAF. Eight studies published between 2021 and 2023 with 3,245 patients were included. Six studies involved coronary artery bypass grafting (CABG) surgery; one encompassed various cardiac procedures, and another focused solely on mitral valve surgery. The pooled incidence of POAF was 23.6% [95% confidence interval (CI), 18.7%-29.2%]. Elevated SII significantly increased the odds of POAF by 3.24-fold (odds ratio, 3.24; 95% CI, 1.6-6.55; p = 0.001). SII's pooled sensitivity and specificity for predicting POAF were 0.80 (95% CI, 0.68-0.89) and 0.53 (95% CI, 0.23-0.8), respectively. The SII had moderate predictive accuracy based on a hierarchical summary receiver operating characteristic (HSROC) area under the curve of 0.78 (95% CI, 0.74-0.81). Subgroup analyses, whether focusing on CABG alone or CABG with cardiopulmonary bypass (CPB), both indicated an area under the HSROC curve of 0.78 (95% CI, 0.74-0.81). Elevated SII is significantly correlated with an increased POAF risk following cardiac surgery, highlighting its utility as a predictive biomarker. Considering its moderate diagnostic accuracy, further research is essential for clarifying SII's clinical effectiveness, either as an independent predictor or combined with other risk factors, for stratifying patients at high POAF risk. https://www.crd.york.ac.uk/prospero/, identifier [CRD42023456128].

Diagnostic efficacy of serum presepsin for postoperative infectious complications: a meta-analysis.

Postoperative infectious complications (PICs) are major concerns. Early and accurate diagnosis is critical for timely treatment and improved outcomes. Presepsin is an emerging biomarker for bacterial infections. However, its diagnostic efficacy for PICs across surgical specialties remains unclear. In this study, a systematic search on MEDLINE, Embase, Google Scholar, and Cochrane Library was performed on September 30, 2023, to identify studies that evaluated presepsin for diagnosing PICs. PIC is defined as the development of surgical site infection or remote infection. Pooled sensitivity, specificity, and hierarchical summary receiver operating characteristic (HSROC) curves were calculated. The primary outcome was the assessment of the efficacy of presepsin for PIC diagnosis, and the secondary outcome was the investigation of the reliability of procalcitonin or C-reactive protein (CRP) in the diagnosis of PICs. This meta-analysis included eight studies (n = 984) and revealed that the pooled sensitivity and specificity of presepsin for PIC diagnosis were 76% (95% confidence interval [CI] 68%-82%) and 83% (95% CI 75%-89%), respectively. The HSROC curve yielded an area under the curve (AUC) of 0.77 (95% CI 0.73-0.81). Analysis of six studies on procalcitonin showed a combined sensitivity of 78% and specificity of 77%, with an AUC of 0.83 derived from the HSROC. Meanwhile, data from five studies on CRP indicated pooled sensitivity of 84% and specificity of 79%, with the HSROC curve yielding an AUC of 0.89. Presepsin exhibits moderate diagnostic accuracy for PIC across surgical disciplines. Based on the HSROC-derived AUC, CRP has the highest diagnostic efficacy for PICs, followed by procalcitonin and presepsin. Nonetheless, presepsin demonstrated greater specificity than the other biomarkers. Further study is warranted to validate the utility of and optimize the cutoff values for presepsin. https://www.crd.york.ac.uk/prospero/, identifier CRD42023468358.

Non-invasive skin autofluorescence as a screening method for diabetic retinopathy.

Diabetic retinopathy (DR) is a public health problem and a common cause of blindness. It is diagnosed by fundus examination; however, this is a costly and time-consuming method. Non-invasive skin autofluorescence (SAF) may be an accessible, fast and simple alternative for screening and early diagnosis of DR. The aim of this study was to evaluate the accuracy of SAF as a screening method for DR. A systematic search of MEDLINE, Scopus, and Web of Science databases was performed. Random effects models for sensitivity, specificity, positive likelihood ratio (PLR) and negative likelihood ratio (NLR), diagnostic odds ratio (dOR) value and 95% CIs were used to calculate test accuracy. In addition, hierarchical summary receiver operating characteristic curves (HSROC) were used to summarise the overall test performance. Four studies were included in the meta-analysis. Pooled sensitivity and specificity were 0.79 (95% CI 0.72-0.88; I2 =0.0%) and 0.54 (95% CI 0.32-0.92; I2 =97.0%), respectively. The dOR value for the diagnosis of DR using SAF was 5.11 (95% CI 1.81-14.48: I2 =85.9%). The PRL was 2.17 (95% CI 0.62-7.64) and the NRL was 0.27 (95% CI 0.07-1.03). Heterogeneity was not relevant in sensitivity and considerable in specificity. The 95% confidence region of the HSROC included all studies. SAF as a screening test for DR shows sufficient accuracy for its use in clinical settings. SAF may be an appropriate method for DR screening, and further research is needed to recommend it as a diagnostic method.

Ultrasonography for confirmation of emergency department endotracheal tube placement: a meta-analysis.

This meta-analysis aimed to summarize the evidence on the use of ultrasonography for confirming endotracheal tube placement in emergency departments. We conducted electronic searches on PubMed, Embase, Web of Science, and Cochrane databases. All databases were searched from their inception until February 2023. We selected studies published in English that used ultrasonography to confirm endotracheal tube placement. Case reports, case series, retrospective studies, cadaveric studies, pediatric studies, animal studies, and conference abstracts were excluded. Two reviewers independently extracted and verified data. Forest plots, hierarchical summary receiver operating characteristic (HSROC) curves, and bivariate random-effects models were used to summarize the test performance characteristics. The Stata statistical software package and Meta-DiSc version 1.4 software were used for statistical analysis. A total of 1,772 intubations were analyzed. For the detection of endotracheal tube placement, the estimated pooled sensitivity and specificity were 0.98 (95% CI: 0.97-0.99) and 0.92 (95% CI 0.85-0.95), respectively. The pooled positive and negative likelihood ratios were 11.70 (95% CI: 6.49-21.07) and 0.02 (95% CI: 0.01-0.03), respectively. The diagnostic odds ratio of ultrasonography was 221.13, and the area under the HSROC curve revealed an appropriate accuracy of 0.99. Current evidence supports the use of ultrasonography as a worthwhile alternative for endotracheal tube identification for intubations performed in emergency departments. This method can be used in conjunction with capnography as a preliminary test before final confirmation with capnography.

Performance of urinary C–C motif chemokine ligand 14 for the prediction of persistent acute kidney injury: a systematic review and meta-analysis

BackgroundUrinary C–C motif chemokine ligand 14 (CCL14) has been described as an effective marker for delayed recovery of acute kidney injury (AKI), yet its efficacy has been found to vary between different trials. The goal of this research was to assess the predictive performance of urinary CCL14 as a marker for persistent AKI.MethodsIn accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched the PubMed, Embase, and Cochrane databases up to April 2023 for studies of adults (> 18 years) that reported the diagnostic performance of urinary CCL14. The sensitivity, specificity, number of events, true positive, and false positive results were extracted and evaluated. Hierarchical summary receiver operating characteristic curves (HSROCs) were used to summarize the pooled test performance, and the Grading of Recommendations, Assessment, Development and Evaluations criteria were used to appraise the quality of evidence.ResultsWe included six studies with 952 patients in this meta-analysis. The occurrence of persistent AKI among these patients was 39.6% (377/952). The pooled sensitivity and specificity results of urinary CCL14 in predicting persistent AKI were 0.81 (95% CI 0.72–0.87) and 0.71 (95% CI 0.53–0.84), respectively. The pooled positive likelihood ratio (LR) was 2.75 (95% CI 1.63–4.66), and the negative LR was 0.27 (95% CI 0.18–0.41). The HSROC with pooled diagnostic accuracy was 0.84.ConclusionOur results suggest that urinary CCL14 can be used as an effective marker for predicting persistent AKI.

Quantitative MRI in the Local Staging of Prostate Cancer: A Systematic Review and Meta-Analysis.

Local staging of prostate cancer (PCa) is important for treatment planning. Radiologist interpretation using qualitative criteria is variable with high specificity but low sensitivity. Quantitative methods may be useful in the diagnosis of extracapsular extension (ECE). To assess the performance of quantitative MRI markers for detecting ECE. Systematic review and meta-analysis. 4800 patients from 28 studies with histopathologically confirmed PCa on radical prostatectomy were pooled for meta-analysis. Patients from 46 studies were included for systematic review. Diffusion-weighted, T2-weighted, and dynamic contrast-enhanced MRI at 1.5 T or 3 T. PubMed, Embase, Web of Science, Scopus, and Cochrane databases were searched to identify studies on diagnostic test accuracy or association of any quantitative MRI markers with ECE. Results extracted by two independent reviewers for tumor contact length (TCL) and mean apparent diffusion coefficient (ADC-mean) were pooled for meta-analysis, but not for other quantitative markers including radiomics due to low number of studies available. Hierarchical summary receiver operating characteristic (HSROC) curves were computed for both TCL and ADC-mean, but summary operating points were computed for TCL only. Heterogeneity was investigated by meta-regression. Results were significant if P ≤ 0.05. At the 10 mm threshold for TCL, summary sensitivity and specificity were 0.76 [95% confidence interval (CI) 0.71-0.81] and 0.68 [95% CI 0.63-0.73], respectively. At the 15 mm threshold, summary sensitivity and specificity were 0.70 [95% CI 0.53-0.83] and 0.74 [95% CI 0.60-0.84] respectively. The area under the HSROC curves for TCL and ADC-mean were 0.79 and 0.78, respectively. Significant sources of heterogeneity for TCL included timing of MRI relative to biopsy. Both 10 mm and 15 mm thresholds for TCL may be reasonable for clinical use. From comparison of the HSROC curves, ADC-mean may be superior to TCL at higher sensitivities. 3 TECHNICAL EFFICACY STAGE: 2.

Accuracy of Prediction Models in Diagnosis of Acute Diverticulitis.

The diagnostic score models (DMs) for patients with acute diverticulitis (AcDi) have been rarely evaluated. Therefore, we tried to develop diagnostic models (DMs) to enhance the diagnostic accuracy (DA) of AcDi. In this AAP (acute abdominal pain) cohort, 30 AcDi patients were compared to 1,303 non-AcDi patients, with regard to their i) clinical symptoms (n=22), ii) signs and tests (n=14) as well as iii) laboratory analyses (n=3). The triage was performed at patient arrival to the emergency department (ED) (triage I) and at follow-up (triage II) before final decision. The triage included a suggested diagnosis of the AAP patient. Bivariate random effects meta-analysis was performed separately for 1) the pooled symptoms (n=22), 2) signs & tests (n=17) as well as 3) pooled DMs (I-V) with different cut-offs (with or without triage) to assess the diagnostic accuracy (DA) in detection of AcDi by HSROC (hierarchical summary receiver operating characteristic) curves. In the conventional receiver operating characteristic (ROC) analysis (for test optimization and finding optimal cut-off points), the area under curve (AUC) reached the following values for AcDi: i) DM without triage, AUC=0.843, ii) DM with triage I, AUC=0.866 and iii) DM with triage I and II, AUC=0.926. In the HSROC analysis, the AUC values for detection of AcDi were as follows; i) pooled clinical symptoms, AUC=0.540, ii) pooled clinical signs & tests, AUC=0.556 and iii) pooled DMs globally, AUC=0.853. In roccomp analysis for differences in AUC values: i) and iii) p<0.0001; between ii) and iii) p<0.0001. As confirmed by ROC and HSROC analysis, the new DMs with triage mode proved to be far superior in their DA for AcDi as compared to both symptoms and signs & tests. In the lack of earlier studies, these data report the first evidence that the DM including triage at an ED could improve the detection of AcDi.

Comparative accuracy of biomarkers for the prediction of hospital-acquired acute kidney injury: a systematic review and meta-analysis

BackgroundSeveral biomarkers have been proposed to predict the occurrence of acute kidney injury (AKI); however, their efficacy varies between different trials. The aim of this study was to compare the predictive performance of different candidate biomarkers for AKI.MethodsIn this systematic review, we searched PubMed, Medline, Embase, and the Cochrane Library for papers published up to August 15, 2022. We selected all studies of adults (> 18 years) that reported the predictive performance of damage biomarkers (neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver-type fatty acid-binding protein (L-FABP)), inflammatory biomarker (interleukin-18 (IL-18)), and stress biomarker (tissue inhibitor of metalloproteinases-2 × insulin-like growth factor-binding protein-7 (TIMP-2 × IGFBP-7)) for the occurrence of AKI. We performed pairwise meta-analyses to calculate odds ratios (ORs) and 95% confidence intervals (CIs) individually. Hierarchical summary receiver operating characteristic curves (HSROCs) were used to summarize the pooled test performance, and the Grading of Recommendations, Assessment, Development and Evaluations criteria were used to appraise the quality of evidence.ResultsWe identified 242 published relevant studies from 1,803 screened abstracts, of which 110 studies with 38,725 patients were included in this meta-analysis. Urinary NGAL/creatinine (diagnostic odds ratio [DOR] 16.2, 95% CI 10.1–25.9), urinary NGAL (DOR 13.8, 95% CI 10.2–18.8), and serum NGAL (DOR 12.6, 95% CI 9.3–17.3) had the best diagnostic accuracy for the risk of AKI. In subgroup analyses, urinary NGAL, urinary NGAL/creatinine, and serum NGAL had better diagnostic accuracy for AKI than urinary IL-18 in non-critically ill patients. However, all of the biomarkers had similar diagnostic accuracy in critically ill patients. In the setting of medical and non-sepsis patients, urinary NGAL had better predictive performance than urinary IL-18, urinary L-FABP, and urinary TIMP-2 × IGFBP-7: 0.3. In the surgical patients, urinary NGAL/creatinine and urinary KIM-1 had the best diagnostic accuracy. The HSROC values of urinary NGAL/creatinine, urinary NGAL, and serum NGAL were 91.4%, 85.2%, and 84.7%, respectively.ConclusionsBiomarkers containing NGAL had the best predictive accuracy for the occurrence of AKI, regardless of whether or not the values were adjusted by urinary creatinine, and especially in medically treated patients. However, the predictive performance of urinary NGAL was limited in surgical patients, and urinary NGAL/creatinine seemed to be the most accurate biomarkers in these patients. All of the biomarkers had similar predictive performance in critically ill patients.Trial registrationCRD42020207883, October 06, 2020.

Diagnostic accuracy of artificial intelligence for detecting gastrointestinal luminal pathologies: A systematic review and meta-analysis

Artificial Intelligence (AI) holds considerable promise for diagnostics in the field of gastroenterology. This systematic review and meta-analysis aims to assess the diagnostic accuracy of AI models compared with the gold standard of experts and histopathology for the diagnosis of various gastrointestinal (GI) luminal pathologies including polyps, neoplasms, and inflammatory bowel disease. We searched PubMed, CINAHL, Wiley Cochrane Library, and Web of Science electronic databases to identify studies assessing the diagnostic performance of AI models for GI luminal pathologies. We extracted binary diagnostic accuracy data and constructed contingency tables to derive the outcomes of interest: sensitivity and specificity. We performed a meta-analysis and hierarchical summary receiver operating characteristic curves (HSROC). The risk of bias was assessed using Quality Assessment for Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Subgroup analyses were conducted based on the type of GI luminal disease, AI model, reference standard, and type of data used for analysis. This study is registered with PROSPERO (CRD42021288360). We included 73 studies, of which 31 were externally validated and provided sufficient information for inclusion in the meta-analysis. The overall sensitivity of AI for detecting GI luminal pathologies was 91.9% (95% CI: 89.0-94.1) and specificity was 91.7% (95% CI: 87.4-94.7). Deep learning models (sensitivity: 89.8%, specificity: 91.9%) and ensemble methods (sensitivity: 95.4%, specificity: 90.9%) were the most commonly used models in the included studies. Majority of studies (n = 56, 76.7%) had a high risk of selection bias while 74% (n = 54) studies were low risk on reference standard and 67% (n = 49) were low risk for flow and timing bias. The review suggests high sensitivity and specificity of AI models for the detection of GI luminal pathologies. There is a need for large, multi-center trials in both high income countries and low- and middle- income countries to assess the performance of these AI models in real clinical settings and its impact on diagnosis and prognosis. [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=288360], identifier [CRD42021288360].

Magnetic resonance imaging for evaluation of bowel inflammation and disease activity in Crohn's disease: A systematic review and meta-analysis

BackgroundThe aim of this systematic review and meta-analysis was to determine the performance of magnetic resonance imaging (MRI) in the diagnosis of bowel inflammation and disease activity in Crohn's disease (CD). MethodsMEDLINE, Embase and Web of Science databases of biomedical literature were systematically searched to identify studies that investigated the diagnostic accuracy of MRI in diagnosing bowel inflammation and disease activity in CD by comparing it with reference standards. Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess study quality. The summary sensitivity and specificity were estimated using the bivariate model, and hierarchical summary receiver operating characteristic (HSROC) parameters were calculated and plotted. ResultsOf 5492 citations of interest, 34 articles contained the diagnostic accuracy data. Of these, results for the small bowel and the colorectum were reported separately in 19 studies and jointly by 21 studies. The meta-analytic summary sensitivity and specificity under the bivariate model were 90.9% (95% CI, 85.8%–94.2%) and 90.2% (95% CI, 81.9%–95.0%), respectively. The sensitivities and specificities of individual studies ranged from 55% to 100% and 51% to 100%, respectively. Substantial heterogeneity was observed in both sensitivity (I2=84.9%) and specificity (I2=78.8%). The HSROC curve also showed considerable heterogeneity between studies. ConclusionAlthough the meta-analytic summary accuracy of MRI was high for the diagnosis of bowel inflammation in CD, the summary estimates might be unreliable due to the presence of high heterogeneity.

Predictive accuracy of the shock index for severe postpartum hemorrhage in high-income countries: A systematic review and meta-analysis.

The shock index has been suggested as a screening tool for predicting postpartum hemorrhage (PPH); however, there is little comprehensive evidence regarding its predictive accuracy. This systematic review and meta-analysis aim to investigate the predictive accuracy of the shock index for severe PPH in high-income countries. A comprehensive search was conducted on MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science (from inception to June 2021). Studies assessing the predictive performance of the shock index for PPH in high-income countries were included. Two or more reviewers independently extracted the data and assessed the risk of bias and applicability concerns using the modified Quality Assessment of Diagnostic Accuracy Studies 2 tool. PPH requiring higher-level care, such as blood transfusions, were considered as primary analyses. We described the hierarchical summary receiver-operating characteristic curve for data synthesis. Nine studies were included after the eligibility assessment. All studies were considered to either have a high risk of bias or high applicability concerns. The sensitivity of the four studies that defined severe PPH as PPH requiring blood transfusion ranged from 0.51 to 0.80, whereas their specificity ranged from 0.33 to 0.92. This review shows that the predictive performance of the shock index for severe PPH is inconsistent. Therefore, the evidence for using the shock index alone as a screening tool for PPH in high-income countries is insufficient. This review was prospectively registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN000044230).

Accuracy of non-physician health workers in respiratory rate measurement to identify paediatric pneumonia in low- and middle-income countries: A systematic review and meta-analysis

BackgroundNon-physician health workers play an important role in identifying and treating pneumonia in children in low- and middle-income countries (LMICs). In this systematic review, we summarized the evidence on whether health workers can accurately measure respiratory rate (RR) and identify fast breathing to diagnose pneumonia in children under five years of age.MethodsWe searched MEDLINE, EMBASE, Web of Science, and Scopus from January 1990 to August 2020 without any language restrictions. Reference lists of included studies were also screened for additional records. Studies evaluating the performance of health workers in measuring RR and/or identifying fast breathing compared to a reference standard were included. The methodological quality of the included studies was assessed using the QUADAS-2 tool. A meta-analysis was conducted to report pooled estimates of sensitivity and specificity. Hierarchical summary receiver operating characteristic curve (HSROC) models were fitted, and subgroup and sensitivity analyses were performed to examine the effects of study variables.ResultsWe included 16 studies, eight of which reported the agreement in RR count between health workers and a reference standard. The median agreements were 39%, 47%, and 67% within ±2, ±3, and ±5 breaths per minute, respectively. Among the 16 included studies, we identified 15 studies that reported the accuracy of a health worker classifying breathing into either fast or normal categories compared to a reference standard. The median sensitivity, specificity, accuracy, and kappa value were 77%, 86%, 81%, and 0.75, respectively. Seven studies reporting the accuracy of identifying fast breathing were included in the meta-analysis. The pooled estimates of sensitivity and specificity were 78% (95% CI = 72-82) and 86% (95% CI = 78-91), respectively.ConclusionsDespite the problematic nature of reference standards and their variability across studies, our review suggests that the health worker performance in accurately counting RR is relatively poor. However, their performance shows reasonable specificity and moderate sensitivity in identifying fast breathing. Improving the detection of fast breathing in children with suspected pneumonia among health workers is an important child health programme objective and should be given appropriate priority.

A comparison of qSOFA, SIRS and NEWS in predicting the accuracy of mortality in patients with suspected sepsis: A meta-analysis.

ObjectiveTo identify and compare prognostic accuracy of quick Sequential Organ Failure Assessment (qSOFA) score, Systemic Inflammatory Response Syndrome (SIRS) criteria, and National Early Warning Score (NEWS) to predict mortality in patients with suspected sepsis.MethodsThis meta-analysis followed accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We searched PubMed, EMBASE, Web of Science, and the Cochrane Library databases from establishment of the database to November 29, 2021. The pooled sensitivity and specificity with 95% CIs were calculated using a bivariate random-effects model (BRM). Hierarchical summary receiver operating characteristic (HSROC) curves were generated to assess the overall prognostic accuracy.ResultsData of 62338 patients from 26 studies were included in this meta-analysis. qSOFA had the highest specificity and the lowest sensitivity with a specificity of 0.82 (95% CI: 0.76–0.86) and a sensitivity of 0.46 (95% CI: 0.39–0.53). SIRS had the highest sensitivity and the lowest specificity with a sensitivity of 0.82 (95% CI: 0.78–0.85) and a specificity 0.24 (95% CI: 0.19–0.29). NEWS had both an intermediate sensitivity and specificity with a sensitivity of 0.73 (95% CI: 0.63–0.81) and a specificity 0.52 (95% CI: 0.39–0.65). qSOFA showed higher overall prognostic accuracy than SIRS and NEWS by comparing HSROC curves.ConclusionsAmong qSOFA, SIRS and NEWS, qSOFA showed higher overall prognostic accuracy than SIRS and NEWS. However, no scoring system has both high sensitivity and specificity for predicting the accuracy of mortality in patients with suspected sepsis.

Diagnostic test accuracy of pretreatment collateral score in predicting stroke outcomes after intra-arterial endovascular thrombectomy: a meta-analysis in DSA and CTA.

This study compared the diagnostic accuracy of pretreatment circulation collateral scoring (CS) system using digital subtraction angiography (DSA) and computed tomography angiography (CTA) in predicting favorable functional outcome (FFO) after intra-arterial endovascular thrombectomy (IA-EVT). Subgroup analysis characterizing scoring systems within each category was additionally conducted. We performed a diagnostic meta-analysis to assess the sensitivity and specificity of each CS system by using DSA and CTA, respectively. The hierarchical summary receiver operating characteristic curve (HSROC) models were used to estimate the diagnostic odds ratio (DOR) and area under the curve (AUC). The Bayes theorem was employed to determine posttest probability (PTP). In total, 14 and 21 studies were assessed with DSA and CTA, respectively. In DSA, the pooled sensitivity and specificity were 0.72 (95% CI, 0.63-0.79) and 0.61 (0.53-0.68), respectively, and in the HSROC model, the DOR was 3.94 (2.71-5.73), and the AUC was 0.71 (90.67-0.75). CTA revealed a pooled sensitivity and specificity of 0.74 (0.64-0.82) and 0.53 (0.44-0.62), respectively, and in the HSROC model, the DOR was 3.17 (2.34-4.50), and the AUC was 0.67 (0.63-0.71). With a pretest probability of 26.3%, the CS in DSA and CTA exhibited limited increase of PTPs of 39% and 36%, respectively, in detecting the FFO on day 90. DSA and CTA have comparable accuracy and are limited in predicting the functional outcome. The collateral score systems assessed with DSA and CTA were more suitable for screening than diagnosis for patients before IA-EVT. • Our study revealed the differences of various scoring systems for assessing collateral status. • DSA and CTA have comparable accuracy, but both imaging modalities played relatively limited roles in predicting functional outcome on day 90. • The collateral score systems assessed with DSA and CTA were more suitable for screening than diagnosis for patients before IA-EVT.

Value of D-dimer in predicting various clinical outcomes following community-acquired pneumonia: A network meta-analysis.

Whether high D-dimer level before treatment has any impact on poor outcomes in patients with community-associated pneumonia (CAP) remains unclear. Therefore, we conducted the first meta-analysis focusing specifically on prognostic value of high D-dimer level before treatment in CAP patients. Pubmed, Embase, the Cochrane Central Register of Controlled Trials and World Health Organization clinical trials registry center were searched up to the end of March 2021. Randomized clinical trials (RCT) and observational studies were included to demonstrate the association between the level of D-dimer and clinical outcomes. Data were extracted using an adaptation of the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies (CHARMS-PF). When feasible, meta-analysis using random-effects models was performed. Risk of bias and level of evidence were assessed with the Quality in Prognosis Studies tool and an adaptation of Grading of Recommendations Assessment, Development, and Evaluation. Data were analyzed using STATA 14.0 to complete meta and network analysis. Besides d-dimer levels in CAP patients with poor outcomes, we also analyzed proportion of patients with or without poor outcomes correctly classified by the d-dimer levels as being at high or low risk. The poor outcome includes severe CAP, death, pulmonary embolism (PE) and invasive mechanical ventilators. 32 studies with a total of 9,593 patients were eventually included. Pooled effect size (ES) suggested that d-dimer level was significantly higher in severe CAP patients than non-severe CAP patients with great heterogeneity (SMD = 1.21 95%CI 0.87-1.56, I2 = 86.8% p = 0.000). D-dimer level was significantly elevated in non-survivors compared to survivors with CAP (SMD = 1.22 95%CI 0.67-1.77, I2 = 85.1% p = 0.000). Prognostic value of d-dimer for pulmonary embolism (PE) was proved by hierarchical summary receiver operating characteristic curve (HSROC) with good summary sensitivity (0.74, 95%CI, 0.50-0.89) and summary specificity (0.82, 95%CI, 0.41-0.97). Network meta-analysis suggested that there was a significant elevation of d-dimer levels in CAP patients with poor outcome than general CAP patients but d-dimer levels weren't significantly different among poor outcomes. The prognostic ability of d-dimer among patients with CAP appeared to be good at correctly identifying high-risk populations of poor outcomes, suggesting potential for clinical utility in patients with CAP.