Abstract
Lipoarabinomannan (LAM) is a potential marker of active tuberculosis (TB). We performed a systematic review and meta-analysis regarding use of urinary LAM assays for diagnosing active TB.
We systematically searched for published and unpublished studies that evaluated urinary LAM for active TB diagnosis. Extracted data were pooled using bivariate random effects models and hierarchical summary receiver operating characteristic curves. Heterogeneity was explored through subgroup analysis and meta-regression. Quality was assessed according to standardised QUADAS (Quality Assessment of Diagnostic Accuracy Studies) criteria.
In seven studies that assessed test accuracy in microbiologically confirmed cases only, estimates of sensitivity ranged from 13% to 93%, while specificity ranged from 87% to 99%. In five studies that assessed accuracy in clinical and confirmed TB cases, sensitivity ranged from 8% to 80%, while specificity ranged from 88% to 99%. In five studies with results stratified by HIV status, sensitivity was 3–53% higher in HIV-positive than HIV-negative subgroups; sensitivity was highest with advanced immunosuppression.
The LAM urinary assay has several characteristics that make it attractive for diagnosing active TB, but has suboptimal sensitivity for routine clinical use. Further studies are needed to evaluate the potential value of the LAM assay in individuals with advanced HIV or for diagnosis of paediatric TB.
Footnotes
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Support Statement
This study was supported by funding from the Technology, Research, Education and Technical Assistance for Tuberculosis (TREAT TB) initiative by the International Union Against Tuberculosis and Lung Disease (IUATLD), with funding support from the United States Agency for International Development (USAID). J. Minion is a recipient of a Quebec Respiratory Health Training Fellowship. M. Pai is a recipient of a Canadian Institutes of Health Research (CIHR) New Investigator Award and also a consultant to the Bill & Melinda Gates Foundation. D. Menzies is a recipient of a Chercheur National salary award from the Fonds de Recherche en Santé du Québec (FRSQ). K. Dheda is supported by a South African Research Chair Initiative award, a Medical Research Council Career Development Fellowship, the European Union (Framework Programme 7, project TBsusgent) and the European and Developing Countries Clinical Trials Partnership (EDCTP; projects Trials of Excellence in Southern Africa (TESA) and New and Emerging Technologies for TB diagnosis (TB-NEAT)). None of these funding agencies had any role in the design and conduct of this study.
Statement of Interest
None declared.
- Received February 10, 2011.
- Accepted May 7, 2011.
- ©ERS 2011