Accuracy of the direct agglutination test for diagnosis of visceral leishmaniasis: a systematic review and meta-analysis.
Accuracy of the direct agglutination test for diagnosis of visceral leishmaniasis: a systematic review and meta-analysis.
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DOI：
10.1186/s12879-023-08772-1
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发表时间：
2023-11-09
影响因子：
3.7
通讯作者：
Ashley, Elizabeth A.
中科院分区：
文献类型：
--
作者：
Roberts, Tamalee;Keddie, Suzanne H.;Rattanavong, Sayaphet;Gomez, Santiago Rayment;Bradley, John;Keogh, Ruth H.;Barenbold, Oliver;Falconer, Jane;Mens, Petra F.;Hopkins, Heidi;Ashley, Elizabeth A.
骨髓、脾脏或淋巴结穿刺的寄生虫学检查是诊断内脏利什曼病 (VL) 的金标准。然而，这种侵入性测试需要熟练的临床和实验室人员以及足够的设施，并且灵敏度根据所使用的组织而变化。直接凝集试验（DAT）是一种血清学试验，不需要专门的人员，只需要最少的培训。虽然之前的荟萃分析表明，在使用寄生虫学作为诊断参考测试时，DAT 具有较高的敏感性和特异性，但与临床和研究环境中越来越多地使用的其他诊断技术（例如 PCR 和 ELISA）相比，DAT 的荟萃分析尚未完成。我们进行了系统评价，以确定 DAT 与所有可用的人类 VL 实验室诊断测试相比的诊断性能。我们检索了电子数据库，包括 Medline、Embase、Global Health、Scopus、WoS Science Citation Index、Wiley Cochrane Central Register of Controlled Trials、Africa-Wide Information、LILACS 和 WHO Global Index。三位独立评审员筛选了报告并从符合条件的研究中提取了数据。荟萃分析评估了 DAT 的诊断敏感性和特异性。在筛选的 987 个标题中，选择了 358 个进行完整数据提取，78 个纳入分析，报告了来自 19 个国家的 32,822 名参与者。纳入的研究是在 1987 年至 2020 年期间进行的。与任何其他测试相比，使用血清和 DAT 进行的研究荟萃分析显示，汇总敏感性为 95% (95%CrI 90–98%)，汇总特异性为 95% (95%CrI 88–98%)。单独分析时，冻干 DAT 和液体 DAT 的结果相似。 HIV 阳性患者的敏感性较低（90%，CrI 59–98%），有症状患者的特异性较低（70%，CrI 43–89%）。比较不同地理区域时，敏感性中位数最低（89%，CrI 67-97%）位于西亚（五项研究）。这项系统评价和荟萃分析表明，尽管不同患者组和地理位置的敏感性和特异性较低，但 DAT 诊断 VL 的汇总敏感性和特异性较高。本次审查强调了 DAT 方法和制剂缺乏标准化，以及缺乏一些重要地理位置的数据。未来报道良好的研究可以提供更好的证据，为不同患者群体和用例的测试实施提供信息。 CRD42021240830 在线版本包含可在 10.1186/s12879-023-08772-1 获取的补充材料。
Parasitological investigation of bone marrow, splenic or lymph node aspirations is the gold standard for the diagnosis of visceral leishmaniasis (VL). However, this invasive test requires skilled clinical and laboratory staff and adequate facilities, and sensitivity varies depending on the tissue used. The direct agglutination test (DAT) is a serological test that does not need specialised staff, with just minimal training required. While previous meta-analysis has shown DAT to have high sensitivity and specificity when using parasitology as the reference test for diagnosis, meta-analysis of DAT compared to other diagnostic techniques, such as PCR and ELISA, that are increasingly used in clinical and research settings, has not been done. We conducted a systematic review to determine the diagnostic performance of DAT compared to all available tests for the laboratory diagnosis of human VL. We searched electronic databases including Medline, Embase, Global Health, Scopus, WoS Science Citation Index, Wiley Cochrane Central Register of Controlled Trials, Africa-Wide Information, LILACS and WHO Global Index. Three independent reviewers screened reports and extracted data from eligible studies. A meta-analysis estimated the diagnostic sensitivity and specificity of DAT. Of 987 titles screened, 358 were selected for full data extraction and 78 were included in the analysis, reporting on 32,822 participants from 19 countries. Studies included were conducted between 1987–2020. Meta-analysis of studies using serum and DAT compared to any other test showed pooled sensitivity of 95% (95%CrI 90–98%) and pooled specificity of 95% (95%CrI 88–98%). Results were similar for freeze-dried DAT and liquid DAT when analysed separately. Sensitivity was lower for HIV-positive patients (90%, CrI 59–98%) and specificity was lower for symptomatic patients (70%, CrI 43–89%). When comparing different geographical regions, the lowest median sensitivity (89%, CrI 67–97%) was in Western Asia (five studies). This systematic review and meta-analysis demonstrates high estimated pooled sensitivity and specificity of DAT for diagnosis of VL, although sensitivity and specificity were lower for different patient groups and geographical locations. This review highlights the lack of standardisation of DAT methods and preparations, and the lack of data from some important geographical locations. Future well-reported studies could provide better evidence to inform test implementation for different patient populations and use cases. CRD42021240830 The online version contains supplementary material available at 10.1186/s12879-023-08772-1.
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影响因子：
1.9
作者：
Dendukuri, N;Joseph, L
通讯作者：
Joseph, L
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3.8
作者：
Cota, Glaucia Fernandes;de Sousa, Marcos Roberto;Rabello, Ana
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2
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Rutter, CM;Gatsonis, CA
通讯作者：
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Mohebali M;Keshavarz H;Shirmohammad S;Akhoundi B;Borjian A;Hassanpour G;Mamishi S;Mahmoudi S
通讯作者：
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39.2
作者：
Whiting, Penny F.;Rutjes, Anne W. S.;Bossuyt, Patrick M. M.
通讯作者：
Bossuyt, Patrick M. M.