Meta-analysis of diagnostic procedures for Pneumocystis carinii pneumonia in HIV-1-infected patients

被引:89
作者
Cruciani, M
Marcati, P
Malena, M
Bosco, O
Serpelloni, G
Mengoli, C
机构
[1] ULSS 20, Ctr Prevent Med, HIV Outpatient Clin, I-37135 Verona, Italy
[2] Univ Padua, Inst Microbiol, Padua, Italy
关键词
bronchoalveolar lavage; diagnosis; meta-analysis; Pneumocystis carinii pneumonia; sputum induction;
D O I
10.1183/09031936.02.01372002
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Sputum induction is a simple and noninvasive procedure for Pneumocystis carinii pneumonia (PCP) diagnosis in human immunodeficiency virus-1-positive patients, although less sensitive than bronchoalveolar lavage (BAL). In order to obtain an overview of the diagnostic accuracy of sputum induction, a systematic review and meta-analysis of studies reporting the comparative sensitivity and specificity of BAL (the "gold standard") and sputum induction was performed. The odds ratio and related 95%, confidence interval were calculated using summary receiving operating characteristic curves as well as fixed-effect and random-effect models. Based on pooled data, the negative and positive predictive values were calculated for a range of PCP prevalence using a Bavesian approach. Seven prospective studies assessed the comparative accuracy of BAL and sputum induction. On the whole, sputum induction demonstrated 55.5% sensitivity and 98.6% specificity. The sensitivity of sputum induction was significantly higher with immunofluorescence than with cytochemical staining (67.1 versus 43.1%). In settings of 25-60% prevalence of PCP, the positive and negative predictive values ranged 86-96.7 and 66.2-89.8, respectively, with immunofluorescence, and 79-94.4 and 53-83.5% with cytochemical staining. In conclusion, in a setting of low prevalence of Pneumocystis carinii pneumonia, sputum induction, particularly with immunostaining, appears to be adequate for clinical decision-making.
引用
收藏
页码:982 / 989
页数:8
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