Diagnostic value of the cerebrospinal fluid lipoarabinomannan assay for tuberculous meningitis: a systematic review and meta-analysis

Frontiers in Public Health

Public Health

Meng-Meng Zhu¹  Cui-Ping Guan²  Ya-Li Chen²  Mao-Shui Wang²  Yan-An Zhang³ 

[1] Department of Lab Medicine, Shandong Public Health Clinical Center, Shandong University, Jinan, China;Department of Lab Medicine, Shandong Public Health Clinical Center, Shandong University, Jinan, China;Shandong Key Laboratory of Infectious Respiratory Disease, Jinan, China;Shandong Key Laboratory of Infectious Respiratory Disease, Jinan, China;Department of Cardiovascular Surgery, Shandong Public Health Clinical Center, Shandong University, Jinan, China;

关键词: tuberculous meningitis;    lipoarabinomannan;    diagnosis;    meta-analysis;    cerebrospinal fluid;   

DOI  :  10.3389/fpubh.2023.1228134

 received in 2023-05-25, accepted in 2023-08-16,  发布年份 2023

来源: Frontiers

【 摘 要 】

ObjectiveThis systematic review aims to evaluate the diagnostic accuracy of cerebrospinal fluid (CSF) lipoarabinomannan (LAM) assays in detecting tuberculous meningitis (TBM).MethodsA systematic review search was conducted in PubMed and five other databases up to April 2023. Studies that evaluated the diagnostic accuracy of CSF LAM assays were included with either definitive or composite reference standard used as the preferred reference standard. The quality of the included studies was assessed using the QUADAS-2 tool. We performed a bivariate random-effects meta-analysis and calculated the summary diagnostic statistics.ResultsA total of six studies, including a sample size of 999, were included in the final analysis. The pooled sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of CSF LAM for diagnosing TBM were determined to be 0.44 (95% CI: 0.31–0.58), 0.89 (95% CI: 0.81–0.93), and 0.76 (95% CI: 0.73–0.80), respectively. Significant heterogeneity was observed in both sensitivity (Q = 73.82, p < 0.01; I2 = 86.45, 95%CI: 79.64–93.27) and specificity (Q = 95.34, p < 0.01; I2 = 89.51, 95% CI: 84.61–94.42). Regression analysis indicated that the study design (retrospective vs. prospective) was associated with the heterogeneity of pooled sensitivity and specificity (all p < 0.05).ConclusionAlthough more prospective studies are required to validate the role of the CSF LAM assay, current evidence supports that the performance of the CSF LAM assay is unsatisfactory for the TBM diagnosis. Additionally, the optimization of the CSF LAM assay (e.g., improvements in CSF collection and preparation methods) should be considered to improve its performance.

【 授权许可】

Unknown   
Copyright © 2023 Chen, Zhu, Guan, Zhang and Wang.