Summary of findings'. 'Summary of results table: different cut‐offs.
|
What is the diagnostic accuracy of the galactomannan ELISA for invasive aspergillosis for different cut‐off values? Patients/population: immunocompromised patients, mostly haematology patients Prior testing: varied, mostly underlying disease or symptoms (fever, neutropenia) Setting: mainly haematology or cancer departments, mainly inpatients Index test: a sandwich ELISA for galactomannan, an Aspergillus antigen Importance: depends on the time‐gain the test may give Reference standard: gold standard is autopsy, but that is almost never done; in most studies therefore the reference standard is composed of clinical and microbiological criteria Studies: patient series or case‐control studies, not using an in‐house test and not excluding possibly infected patients. Studies had to report cut‐off values that were used (n = 29). Each study can be present in more than one subgroup | |||||
| Subgroup |
Effect (95% CI) |
No. of participants (studies) |
Prevalence (median, range) |
Comments | What do these results mean? |
| Cut‐off 0.5 |
Sensitivity 0.78 (0.70 to 0.85) Specificity 0.85 (0.78 to 0.91) |
394 proven or probable 3549 possible or no IA (27) |
Median 11% (IQR 6.5% to 16%) |
— | With a prevalence of 11%*, 11 out of 100 patients will develop IA Of these, 2 will be missed by the Platelia test (22% of 11), but will be tested again Of the 89 patients without IA, 13 will be unnecessarily referred for CT scanning |
| Cut‐off 1.0 |
Sensitivity 0.71 (0.63 to 0.78) Specificity 0.90 (0.86 to 0.93) |
145 proven or probable 1246 possible or no IA (8) |
Median 13% (IQR 4.2% to 31%) |
— | With a prevalence of 11%*, 11 out of 100 patients will develop IA Of these, 3 will be missed by the Platelia test (29% of 11), but will be tested again Of the 89 patients without IA, 9 will be unnecessarily referred for CT scanning |
| Cut‐off 1.5 |
Sensitivity 0.63 (0.49 to 0.77) Specificity 0.93 (0.89 to 0.97) |
209 proven or probable 2412 possible or no IA (15) |
Median 7.4% (IQR 4.3% to 16%) |
— | With a prevalence of 11%*, 11 out of 100 patients will develop IA Of these, 4 will be missed by the Platelia test (36% of 11), but will be tested again Of the 89 patients without IA, only 6 will be unnecessarily referred for CT scanning |
| Children |
Sensitivity 0.84 (0.66 to 0.93) Specificity 0.88 (0.60 to 0.97) |
47 proven or probable 308 possible or no IA (in 6 studies) |
Median 16% (IQR 10% to 16%) |
5 studies had a cut‐off of 0.5 and one had a cut‐off of 1.5 | Of the 100 children, 16 had IA Of these, 2 or 3 (2.5) will be missed; while 10 out of the 84 children without IA will test positive and be referred unnecessarily for CT scanning |
* Median prevalence over all studies was 11% (range 0.8% to 56%).
CI: confidence interval; CT: computerised tomography; ELISA: enzyme‐linked immunosorbent assay; IA: invasive aspergillosis; IQR: interquartile range