RT Journal Article
SR Electronic
T1 Diagnosing tuberculosis with urine lipoarabinomannan: systematic review and meta-analysis
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP erj00257-2011
DO 10.1183/09031936.00025711
A1 J. Minion
A1 E. Leung
A1 E. Talbot
A1 K. Dheda
A1 M. Pai
A1 D. Menzies
YR 2011
UL http://erj.ersjournals.com/content/early/2011/07/04/09031936.00025711.abstract
AB Lipoarabinomannan (LAM) is a potential marker of active 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 We systematically searched for published and unpublished studies that evaluated urinary LAM for active TB diagnosis.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 was 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 standardized QUADAS criteria. In 7 studies that assessed test accuracy in microbiologically confirmed cases only, estimates of sensitivity ranged from 13% to 93%, while specificity ranged from 87 – 99%. In 5 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 which 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.