Diagnostic accuracy of stool assays for inflammatory bacterial gastroenteritis in developed and resource-poor countries.
Diagnostic accuracy of stool assays for inflammatory bacterial gastroenteritis in developed and resource-poor countries.
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DOI：
10.1086/375896
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发表时间：
2003-08
期刊：
影响因子：
--
通讯作者：
C. Gill;J. Lau;S. Gorbach;D. Hamer
中科院分区：
文献类型：
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作者：
C. Gill;J. Lau;S. Gorbach;D. Hamer
由于急性细菌性胃肠炎通常是炎症性的，因此可以使用快速粪便检测来检测肠道炎症，以区分细菌性和非细菌性胃肠炎。我们进行了荟萃分析，以确定在发达国家和资源贫乏的国家，快速粪便检测，检测乳铁蛋白，粪便白细胞，粪便红细胞和潜血的区分能力。在发达国家，粪便白细胞和潜血的受试者工作特征曲线下面积（AUC/SROC）分别为0.89和0.81。在资源贫乏的国家，乳铁蛋白的AUC/SROC为0.79，粪便白细胞为0.72，潜血为0.63，粪便红细胞为0.61。在发达国家，正负似然比当使用>5个细胞/高倍视野的阈值时，粪便白细胞的LR+和LR-分别为4.56和0.32，而资源贫乏国家为2.94和0.6;对于乳铁蛋白，当阈值为凝集评级“+”和稀释度1：50时，资源贫乏国家的LR+为1.34，LR-为0.17。在发展中国家，快速粪便检测表现不佳，而在发达国家，粪便白细胞，乳铁蛋白和潜血的测试是中等有用的，可以确定谁更有可能从经验性抗生素治疗中受益的患者。
Because acute bacterial gastroenteritis is often inflammatory, rapid stool assays that detect intestinal inflammation might be used to distinguish between bacterial and nonbacterial gastroenteritis. We performed meta-analyses to determine the discriminatory power, in developed and in resource-poor countries, of rapid stool assays that test for lactoferrin, fecal leukocytes, fecal erythrocytes, and occult blood. In developed countries, the area under the summary receiver operating characteristic curve (AUC/SROC) was 0.89 for fecal leukocytes and 0.81 for occult blood. In resource-poor countries, the AUC/SROC was 0.79 for lactoferrin, 0.72 for fecal leukocytes, 0.63 for occult blood, and 0.61 for fecal erythrocytes. In developed countries, positive and negative likelihood ratios (LR+ and LR-, respectively) for fecal leukocytes were 4.56 and 0.32 when a threshold of >5 cells/high-power field was used, compared with 2.94 and 0.6 in resource-poor countries; for lactoferrin, LR+ was 1.34 and LR- was 0.17 in resource-poor countries when the threshold was an agglutination rating of "+" and a dilution of 1:50. In developing countries, rapid stool assays performed poorly, whereas in developed countries, tests for fecal leukocytes, lactoferrin, and occult blood were moderately useful and could identify patients who were more likely to benefit from empirical antibiotic therapy.