Table 5.
Results of meta-analyses for diagnostic accuracy of PJP and IFIa with serum 1,3-β-d-glucan
| Test | No. of studies | % sensitivity (95% CI) | % specificity (95% CI) % | Diagnostic odds ratio (95% CI) | AUC-SROC (95% CI) |
|---|---|---|---|---|---|
| PJP | |||||
| All data | 12 | 96 (92–98) | 84 (83–86) | 102.3 (59.2–176.6) | 0.96 (0.94–0.99) |
| Healthy control excluded | 12 | 96 (92–98) | 84 (82–86) | 99.8 (57.8–172.4) | 0.96 (0.94–0.99) |
| Effect of HIV status | |||||
| HIV-positive patients | 5 | 95 (90–98) | 85 (82–88) | 117.3 (55.0–250.4) | 0.97 (0.95–0.99) |
| HIV-negative patients | 5 | 97 (83–100) | 83 (81–85) | 50.3 (15.0–169.4) | 0.93 (0.80–1.00) |
| Effect of study design | |||||
| Cohort study | 3 | 100 (59–100) | 78 (73–83) | 20.1 (3.4–117.8) | 0.91 (0.74–1.00) |
| Case-control study | 9 | 95 (92–98) | 85 (84–87) | 121.4 (68.4–215.6) | 0.97 (0.95–0.99) |
| Effect of assay type | |||||
| Fungitell | 5 | 98 (93–100) | 83 (81–85) | 139.2 (44.5–435.5) | 0.96 (0.88–1.00) |
| Fungitec G test | 4 | 94 (89–98) | 88 (85–90) | 117.8 (53.8–258.3) | 0.97 (0.94–0.99) |
| Only paper in English included | 10 | 95 (92–98) | 85 (83–87) | 112.8 (64.1–198.4) | 0.96 (0.94–0.99) |
| Effect of methodological quality (representative spectrum) | |||||
| Yes (no bias) | 8 | 95 (92–98) | 84 (83–86) | 100.5 (55.9–180.6) | 0.86 (0.61–1.00) |
| No (potential bias) | 4 | 97 (86–100) | 84 (80–88) | 115.2 (25.6–517.0) | 0.97 (0.93–1.00) |
| IFI | |||||
| All data | 31 | 80 (77–82) | 82 (81–83) | 25.7 (15.0–44.1) | 0.88 (0.82–0.93) |
| Healthy control excluded | 28 | 78 (75–81) | 80 (79–82) | 19.2 (11.0–33.7) | 0.86 (0.81–0.92) |
| Per event excluded | 26 | 80 (77–83) | 82 (80–83) | 25.3 (14.0–45.8) | 0.90 (0.86–0.95) |
| Possible IFI in control excluded | 28 | 81 (78–83) | 82 (81–84) | 30.7 (16.4–57.5) | 0.89 (0.83–0.94) |
| Effect of study design | |||||
| Cohort study | 17 | 72 (67–77) | 78 (76–80) | 12.3 (6.0–25.1) | 0.79 (0.73–0.85) |
| Case-control study | 14 | 83 (80–86) | 86 (84–88) | 68.3 (30.7–151.8) | 0.95 (0.92–0.98) |
| Effect of reference standard | |||||
| EORTC/MSG | 17 | 77 (70–78) | 83 (81–84) | 15.2 (8.5–27.3) | 0.80 (0.73–0.86) |
| Similar criteria | 14 | 86 (82–90) | 81 (79–83) | 61.4 (20.3–185.5) | 0.95 (0.90–0.99) |
| Effect of assay type | |||||
| Fungitell | 15 | 75 (71–79) | 77 (75–79) | 12.0 (6.1–23.7) | 0.86 (0.79–0.93) |
| Fungitec G test | 7 | 89 (83–93) | 90 (88–92) | 100.7 (23.2–437.6) | 0.96 (0.96–1.00) |
| Wako | 5 | 84 (77–90) | 90 (87–92) | 60.1 (11.2–321.3) | 0.94 (0.86–1.00) |
| Effect of kind of mycosis | |||||
| Candidiasis | 19 | 81 (77–85) | 81 (80–83) | 25.7 (12.9–51.2) | 0.90 (0.85–0.95) |
| Aspergillosis | 17 | 77 (71–82) | 83 (82–85) | 23.2 (9.9–54.4) | 0.86 (0.77–0.94) |
| Effect of antifungal therapy | 12 | 81 (77–85) | 84 (82–85) | 25.9 (10.0–66.8) | 0.87 (0.78–0.96) |
| Only papers in English included | 23 | 79 (76–82) | 83 (82–84) | 26.8 (13.9–51.5) | 0.87 (0.80–0.95) |
| Effect of methodological quality (representative spectrum) | |||||
| Yes (no bias) | 18 | 71 (66–76) | 80 (78–81) | 11.8 (6.4–21.9) | 0.78 (0.71–0.85) |
| No (potential bias) | 13 | 85 (82–88) | 87 (85–89) | 89.3 (36.4–219.1) | 0.96 (0.93–0.98) |
a
PJP, Pneumocystis jiroveci pneumonia; HIV, human immunodeficiency virus; IFI, invasive fungal infection; EORTC/MSG, the European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria.