Zhang 1992.

Study characteristics
Patient sampling	Unclear study design, selection procedures not reported.
Patient characteristics and setting	Sample size: 132 cases, 43 non‐cases (total 175) Clinical presentation: NR Risk factors: NR Region: China Clinical setting: NR Prevalence of leptospirosis: 75.4% (assuming cross‐sectional design) DPO of disease at moment of enrolment: NR ("early")
Index tests	Index test: PCR Target gene: 23S rRNA (Zhang 1992) Timing of sample collection at # DPO of disease: 1–5 DPO Cut‐off value: not applicable Patient material: serum Company/brand: inhouse Frozen samples: unclear
Target condition and reference standard(s)	Target condition: leptospirosis Case definition: MAT positive or culture positive, or both Timing of sample collection at # DPO of disease (MAT): 1–5 DPO and 14–21 DPO Single or paired sera (MAT): paired Cut‐off value (MAT): seroconversion or a 4‐fold titre rise Patient material (MAT): serum Timing of sample collection at # DPO of disease (culture): 1–5 DPO Patient material (culture): whole blood
Flow and timing	All people were included in the analysis.
Comparative
Notes
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled?	Unclear
Was a 2‐gate case‐control design avoided?	Yes
Did the study avoid inappropriate exclusions?	Unclear
		Unclear	Unclear
DOMAIN 2: Index Test PCR
Were the index test results interpreted without knowledge of the results of the reference standard?	Yes
If a threshold was used, was it pre‐specified?	Yes
Does the index test, its conduct and interpretation, match the review question?	Unclear
Is the execution of the test reported in such detail that reproduction is possible?	No
		Low	High
DOMAIN 3: Reference Standard
Is this the type of test that is likely to correctly classify the target condition?	Yes
Did the execution of the MAT include paired samples?	Unclear
Were the reference standard results interpreted without knowledge of the results of the index tests?	Yes
Does the case definition match the review question?	Yes
Is the execution of the test reported in such detail that reproduction is possible?	No
		Low	High
DOMAIN 4: Flow and Timing
Was there an appropriate interval between index test and reference standard?	Unclear
Did all patients receive a reference standard?	Yes
Did all patients receive the same reference standard?	Yes
Were all patients included in the analysis?	Yes
		Low

Ct: threshold cycle; DPO: days postonset; EDTA: ethylenediaminetetraacetic acid; ICG‐LFA: immunochromatography‐based lateral flow assay; ICU: intensive care unit; IgM ELISA: immunoglobulin M enzyme‐linked immunosorbent assay; IQR: interquartile range; LAMP: loop‐mediated isothermal amplification; MAT: microscopic agglutination test; NR: not reported; PCR: polymerase chain reaction; rDNA: ribosomal DNA; rRNA: ribosomal ribonucleic acid.