PLoS One. 2011; 6(12): e28467
Sun W, Wang K, Gao W, Su X, Qian Q, Lu X, Song Y, Guo Y, Shi Y
BACKGROUND: Nucleic acid detection by polymerase chain reaction (PCR) is emerging as a sensitive as well as rapid evidence tool. PCR assays upon serum have a potential to be a practical evidence tool. However, PCR upon bronchoalveolar lavage fluid (BALF) has not been well established. We performed a systematic review of published studies to weigh a evidence correctness of PCR assays upon BALF for invasive aspergillosis (IA). METHODS: Relevant published studies were shortlisted to weigh a quality of their methodologies. A bivariate retrogression approach was used to calculate pooled values of a method sensitivity, specificity, as well as positive as well as negative likelihood ratios. Hierarchical outline receiver operating characteristic curves were used to summarize overall performance. We calculated a post-test probability to weigh clinical usefulness. Potential heterogeneity among studies was explored by subgroup analyses. RESULTS: Seventeen studies comprising 1191 at-risk patients were selected. The outline estimates of a BALF-PCR test for proven as well as probable IA were as follows: sensitivity, 0.91 (95% confidence interval (CI), 0.79-0.96); specificity, 0.92 (95% CI, 0.87-0.96); positive likelihood ratio, 11.90 (95% CI, 6.80-20.80); as well as negative likelihood ratio, 0.10 (95% CI, 0.04-0.24). Subgroup analyses showed which a opening of a PCR test was shabby by PCR test methodology, primer design as well as a methods of cell wall disruption as well as DNA extraction. CONCLUSIONS: PCR test upon BALF is highly accurate for diagnosing IA in immunocompromised patients as well as is likely to be a utilitarian evidence tool. However, further efforts towards devising a standard protocol are needed to capacitate grave validation of BALF-PCR.
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