β-Glucan Antigenemia Assay for the Diagnosis of Invasive Fungal Infections in Patients With Hematological Malignancies: A Systematic Review and Meta-Analysis of Cohort Studies From the Third European Conference on Infections in Leukemia (ECIL-3)
β-Glucan Antigenemia Assay for the Diagnosis of Invasive Fungal Infections in Patients With Hematological Malignancies: A Systematic Review and Meta-Analysis of Cohort Studies From the Third European Conference on Infections in Leukemia (ECIL-3)
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DOI：
10.1093/cid/cir897
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发表时间：
2012-03-01
影响因子：
11.8
通讯作者：
Marchetti, Oscar
中科院分区：
文献类型：
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作者：
Lamoth, Frederic;Cruciani, Mario;Marchetti, Oscar
侵袭性真菌感染（IFIs）是恶性血液肿瘤患者的致命并发症，早期诊断对预后至关重要。化合物1，3-β-D-葡聚糖（BG）是大多数真菌物种的细胞壁成分，在IFI期间可以在血液中检测到。有四种市售BG抗原血症检测试剂（Fungitell、Fungitec-G、和子和Maruha）。这项来自第三届欧洲白血病感染会议（ECIL-3）的Meta分析评估了BG检测在血液肿瘤患者中诊断IFI的性能。确定了报告BG抗原血症检测试剂盒诊断血液肿瘤患者IFI（欧洲癌症和真菌病研究与治疗组织标准）性能的研究。分析重点是高质量的队列研究，排除病例对照研究。Meta分析采用常规Meta分析合并和双变量分析。纳入了6项队列研究（1771例成人患者，414例IFI，其中215例经证实或可能）。在不同的BG测定中观察到相似的性能。对于制造商推荐的临界值，BG检测试剂盒在经证实或可能的IFI中的诊断性能更好，连续2次检测结果为阳性（2个连续阳性结果与1个单一阳性结果的诊断比值比分别为111.8 [95%置信区间{CI}，38.6-324.1]与16.3 [95% CI，6.5-40.8]; 2个连续阳性结果与1个单一阳性结果的异质性指数分别为0%与72.6%）。连续2次检测的敏感性和特异性分别为49.6%（95%CI，34.0%-65.3%）和98.9%（95%CI，97.4%-99.5%）。IFI患病率10%的阳性和阴性预测值分别为83.5%和94.6%。不同的BG检测方法对血液肿瘤患者IFI的诊断具有相似的准确性。连续两次阳性抗原血症检测具有非常高的特异性、阳性预测值和阴性预测值。由于灵敏度低，该测试需要结合临床，放射学和微生物的发现。
Invasive fungal infections (IFIs) are life-threatening complications in patients with hematooncological malignancies, and early diagnosis is crucial for outcome. The compound 1,3-beta-D-glucan (BG), a cell wall component of most fungal species, can be detected in blood during IFI. Four commercial BG antigenemia assays are available (Fungitell,Fungitec-G, Wako, and Maruha). This meta- analysis from the Third European Conference on Infections in Leukemia (ECIL-3) assessed the performance of BG assays for the diagnosis of IFI in hematooncological patients.Methods. Studies reporting the performance of BG antigenemia assays for the diagnosis of IFI (European Organization for Research and Treatment of Cancer and Mycoses Study Group criteria) in hemato-oncological patients were identified. The analysis was focused on high-quality cohort studies with exclusion of case-control studies. Meta-analysis was performed by conventional meta-analytical pooling and bivariate analysis.Results. Six cohort studies were included (1771 adult patients with 414 IFIs of which 215 were proven or probable). Similar performance was observed among the different BG assays. For the cutoff recommended by the manufacturer, the diagnostic performance of the BG assay in proven or probable IFI was better with 2 consecutive positive test results (diagnostic odds ratio for 2 consecutive vs one single positive results, 111.8 [95% confidence interval {CI}, 38.6-324.1] vs 16.3 [95% CI, 6.5-40.8], respectively; heterogeneity index for 2 consecutive vs one single positive results, 0% vs 72.6%, respectively). For 2 consecutive tests, sensitivity and specificity were 49.6% (95% CI, 34.0%-65.3%) and 98.9% (95% CI, 97.4%-99.5%), respectively. Estimated positive and negative predictive values for an IFI prevalence of 10% were 83.5% and 94.6%, respectively.Conclusions. Different BG assays have similar accuracy for the diagnosis of IFI in hemato-oncological patients. Two consecutive positive antigenemia assays have very high specificity, positive predictive value, and negative predictive value. Because sensitivity is low, the test needs to be combined with clinical, radiological, and microbiological findings.